Neisseria

Mol Microbiol, 1991 Jun, 5(6), 1531 - 8
Enhancement of the invasive ability of Neisseria gonorrhoeae by contact with HecIB, an adenocarcinoma endometrial cell line; Chen JC et al.; Since Neisseria gonorrhoeae is an obligate pathogen, there is no animal model for identification of virulence factors for this bacterium . An alternative model for assessment of gonococcal virulence is invasion of the adenocarcinoma endometrial cell line, HecIB . Preincubation of gonococci with glutaraldehyde-fixed HecIB cells eliminated the six- to eight-hour lag in entry of bacteria into a fresh HeIIB monolayer seen with unpreincubated gonococci or gonococci preincubated in tissue-culture medium alone . Gonococci tightly bound to fixed HecIB cells were more invasive than cells free in the tissue-culture medium, suggesting that actual contact with HecIB cells was required for the enhancement of invasive ability . Chloramphenicol addition during the preincubation prevented the enhanced invasion . Preincubated gonococci were not more adherent to HecIB cells, suggesting that a stage in invasion after binding of gonococci to HecIB cells was enhanced . The enhanced invasion occurred only when gonococci were preincubated with HecIB cells and not with HEp-2, HeLa, Chang or CHO cells . This eukaryotic cell specificity for induction of enhanced invasion may indicate a role for invasion in gonococcal infection of the endometrium.

East Afr Med J, 1991 Jun, 68(6), 425 - 9
Long distance truck-drivers: 1 . Prevalence of sexually transmitted diseases (STDs); Bwayo JJ et al.; A cross section study was conducted among long distance truck drivers to determine the prevalence of sexually transmitted diseases (STDs) and antibodies to human immunodeficiency virus (HIV) . A total of 8 drivers and their assistants en route from port of Mombasa to countries in East and Central Africa were enrolled into the study . Blood was taken for HIV and syphilis serology . Discharges from urethra and genital ulcer disease (GUD) were cultured . Seroprevalence for HIV was 18% and 4.6% for syphilis . Fifty percent of Neisseria Gonorrhea cultured were penicillinase producers . Most of the men with urethral discharge and all the GUD were culture negative, probably due to prior treatment . Lack of circumcision, past history of GUD and urethritis were significantly associated with HIV seroconversionPIP: This article reports the findings of a study of HIV and STDs prevalence among long-distance truck drivers from East and Central Africa . Similar to prostitutes, truck drivers and a highly mobile population, characterized by having multiple sex partners . The researchers established a tent clinic at the Athi River Weighbridge Police Station near Nairobi, Kenya, where convoys of trucks stop for 3-5 days . 331 men from several East and Central African countries participated in the study . The participants completed a standard questionnaire about their medical history, knowledge, attitudes, and sex practices, and underwent a physical examination and blood test . Their ages ranged from 18-61 years, with a mean age of 31 years . 18% of the participants tested positive for HIV . Additionally, 4.6% tested positive for syphilis, and 4.5% and 4.3% suffered from urethral discharge ranked as the highest risk factor, followed by lack of circumcision . The study found no difference in the HIV prevalence rate between married and single men . The prevalence rate was far higher among Central Africans (31.75%) than among East Africans (16.65%), possibly explained by the hypothesis that says that HIV was first introduced in Central Africa, from where it spread to East Africa . Older drivers where more likely to be infected with HIV than younger drivers, with the age group of 40-49 having the highest prevalence rate . Researchers suspect that this is due to the fact that older drivers have been exposed longer and have more money with which to purchase sex . The report concludes that truck drivers constitute a high risk group, and should be targeted accordingly, with education and condom use campaigns .

P N G Med J, 1991 Jun, 34(2), 149 - 54
The diagnosis and management of common forms of arthritis in adults in Papua New Guinea; Richens J; Reactive arthritis is the leading cause of arthritis in Papua New Guinea, followed probably by gonococcal arthritis . Indomethacin and local hydrocortisone acetate are useful in the treatment of reactive arthritis . Refractory cases of reactive arthritis may be helped by weekly low-dose oral methotrexate or by long courses of doxycycline . When Neisseria gonorrhoeae is thought to be involved treatment should cover penicillinase-producing strains . Infective arthritis due to Staphylococcus aureus and Mycobacterium tuberculosis is less common but should be considered in all patients because prompt and specific treatment is required to avoid permanent damage.

Bull Acad Natl Med, 1991 Jun-Jul, 175(6), 823 - 34
{Molecular bases of virulence in Neisseria gonorrhoeae}; Marchal C et al.; Gonorrhea remains of clinical concern, due to its frequency, complications, sequelae, increasing prevalence of antibiotic-resistant strains and absence of vaccine . A better understanding of the first stages of infection as well as of mechanisms of escape to immune response appears important . Many pathogenic bacteria express pili on their all surfaces . These structures mediate binding of bacteria to host tissues . Furthermore, gonococcal pili are submitted to a high rate antigenic variation, allowing the escape to host immune response . Pilin antigenic variation occurs by DNA recombination between one of the silent partial variant gene segments and an expressed pilin genes . We have shown that transformation of living bacteria by DNA liberated from lysed cells is a critical strep for antigenic variation . This constitutes the first specific function for a DNA transformation system . Piliation and virulence can change with culture conditions . This observation suggests that pilin expression would be subjected to an adaptative response . We have identified and characterized two genes which act in trans to regulate pilus expression . They determine synthesis of a response regulator and a membrane located sensor . They appear to regulate expression of other genes, possibly also involved in virulence . We present evidence for several environmental factors which may control the degree of piliation.

EMBO J, 1991 Jun, 10(6), 1307 - 15
Phase variation of the opacity outer membrane protein controls invasion by Neisseria gonorrhoeae into human epithelial cells; Makino S et al.; Neisseria gonorrhoeae is a facultative intracellular bacterium capable of penetrating into certain human epithelial cell types . In order to identify gonococcal factors essential for invading Chang human conjunctiva cells, a gentamicin selection assay for the quantification of viable intracellular bacteria was used in conjunction with microscopy . The results demonstrate a correlation between the invasive behaviour of gonococci and the expression of Opa proteins, a family of variable outer membrane proteins present in all pathogenic Neisseria species . However, only particular Opa proteins supported invasion into Chang cells as indicated by the use of two unrelated gonococcal strains . Invasion was sensitive to cytochalasin D, and strong adherence mediated by the Opa proteins appeared to be essential for the internalization of gonococci . In contrast pili, which also conferred binding to Chang conjunctiva cells, did not support cellular invasion but rather were inhibitory.

Am J Obstet Gynecol, 1991 May, 164(5 Pt 2), 1396 - 9
The clinical experience with ofloxacin in the treatment of sexually transmitted diseases; Corrado ML; Sexually transmitted diseases are an important cause of morbidity in women . Some of the common causes of sexually transmitted disease include Neisseria gonorrhoeae, Chlamydia trachomatis, and in some patients Ureaplasma urealyticum . N . gonorrhoeae has become more resistant to traditional therapies including penicillin . Resistance to penicillin is mediated by the elaboration of beta-lactamase for most organisms and by chromosomal resistance in others . Resistance to tetracycline and spectinomycin has been clearly identified, as has an increase in the minimum inhibitory concentrations to some cephalosporins . Because of the potential for concomitant infection with N . gonorrhoeae and C . trachomatis, many patients are currently treated with a combination of a single dose of ceftriaxone plus a tetracycline for 7 days . Therefore it is significant that a single agent, ofloxacin, has been introduced recently for the treatment of such mixed infections . It also has the potential for treating N . gonorrhoeae resistant to other drugs.

Am J Obstet Gynecol, 1991 May, 164(5 Pt 2), 1390 - 6
A randomized trial of ofloxacin versus cefoxitin and doxycycline in the outpatient treatment of acute salpingitis; Wendel GD Jr et al.; The object of this randomized study was to compare the safety and efficacy of oral ofloxacin, 400 mg twice daily for 10 days, versus intramuscular cefoxitin, 2 gm, plus oral probenecid, 1 gm, followed by oral doxycycline, 100 mg twice daily for 10 days, in the outpatient treatment of uncomplicated acute salpingitis . Thirty-eight women (53%) had Neisseria gonorrhoeae from their pretreatment endocervical or endometrial cultures, and 18 had Chlamydia trachomatis (25%) . Thirty-five of 37 women (95%) treated with the ofloxacin regimen were clinically cured, and 34 of 35 (97%) were cured with the cefoxitin-doxycycline regimen (p = 0.52) . One clinical failure occurred in each group with N . gonorrhoeae infection, and one failure occurred in the ofloxacin group because of side effects . The bacteriologic response for N . gonorrhoeae in both groups was 100% . The eradication of C . trachomatis was 100% (10/10) for the cefoxitin/doxycycline group and 86% (6/7) for ofloxacin . The side effects were similar in both groups of subjects . In this study both regimens were effective for the outpatient treatment of uncomplicated acute salpingitis.

Am J Obstet Gynecol, 1991 May, 164(5 Pt 2), 1380 - 3
Effectiveness of ofloxacin in the treatment of Chlamydia trachomatis and Neisseria gonorrhoeae cervical infection; Faro S et al.; Forty patients with cervical infection caused by Chlamydia trachomatis were treated with ofloxacin (20) or doxycycline (20) . Ofloxacin was successful in eradicating C . trachomatis from all 20 (100%) patients . Doxycycline was effective in 18 of 20 (90%) patients . Three patients had a concomitant cervical gonococcal infection . All three were successfully treated: one with ofloxacin and two with doxycycline . Ofloxacin, 300 mg, taken twice daily for 7 days, is effective in eradicating endocervical C . trachomatis infection.

Mol Microbiol, 1991 May, 5(5), 1097 - 103
Gonococcal penicillin-binding protein 3 and the surface-exposed 44kDa peptidoglycan-binding protein appear to be the same molecule; Shafer WM et al.; The outer membrane of Neisseria gonorrhoeae contains a 44,000 dalton (44kDa) surface-exposed protein which has the reported ability to form covalent interactions with peptidoglycan (PG) . This PG-binding outer-membrane protein (OMP) appears to be highly conserved since it has been detected in all isolates examined . It also appears to be invariant since its primary structure among strains gives evidence of being identical (Judd et al., 1991) . While studying the interaction of gonococcal penicillin-binding proteins (PBPs) with human lysosomal cathepsin G, we noticed that the 44kDa PG-binding OMP exhibited certain properties similar to PBP3 . In this study we sought to obtain biochemical evidence to ascertain whether these proteins were the same . We found that both proteins fractionated with other sarkosyl-insoluble OMPs and that they exhibited similar susceptibility to cleavage in situ by enzymatically active cathepsin G . Moreover, a purified preparation of the 44kDa OMP was found to covalently bind radiolabelled benzylpenicillin in vitro . Thus, the data presented herein suggest that the 44kDa PG-binding OMP and PBP3 are the same OMP.

Mol Microbiol, 1991 May, 5(5), 1091 - 6
Identification and characterization of a conserved outer-membrane protein of Neisseria gonorrhoeae; Judd RC et al.; A previous study in our laboratory identified a surface-exposed peptidoglycan-associated protein of Neisseria gonorrhoeae which had an apparent molecular mass of 44,000 daltons (44kDa) (Hill and Judd, 1989) . This paper reports results which confirm that the 44kDa protein is surface-exposed, and that the protein is expressed in, and is structurally invariant among, 14 strains of N . gonorrhoeae . The fact that the 44kDa outer-membrane protein is found in a conserved form in all gonococci examined strongly suggests that it is crucial to the bacterium's survival . Moreover, it appears that this protein is a penicillin-binding protein (PBP3) (Shafer and Judd, 1991) . This invariant, surface-exposed, peptidoglycan-associated outer-membrane protein deserves further investigation to elucidate its role in the immunobiology of N . gonorrhoeae, and its possible use as an immunoprophylactic reagent.

Pathol Biol (Paris), 1991 May, 39(5), 491 - 4
{First isolation in France of a penicillinase-non producing Neisseria gonorrhoeae with high level tetracycline resistance}; Lefevre JC et al.; We report the first isolation in France of a penicillinase-non producing Neisseria gonorrhoeae with high level tetracycline resistance . The minimal inhibitory concentrations (MICs) of nine antibiotics were determined by agar dilution for the tetracycline resistant strain and 39 other penicillinase-non producing N . gonorrhoeae strains which were isolated during the same year (1989), in Toulouse . No difference was observed between the MICs except for the tetracycline (tetracycline-resistant strain MIC = 32 mg/l) . The commonly used antibiotics other than tetracycline were active in vitro against all the strains . The plasmid content of the tetracycline-resistant strain was analysed by agarose gel electrophoresis and revealed the presence of two plasmids: the 2.6-megadalton in cryptic plasmid and the 25.2-megadalton Tet M conjugative plasmid.

Can J Microbiol, 1991 May, 37(5), 345 - 9
Transformation of Neisseria gonorrhoeae: physical requirements of the transforming DNA; Stein DC; The 1600-bp (base pair) fragment encoding a portion of the nalidixic acid resistant DNA gyrase, subunit B, was characterized to determine what parameters effect transformation in the gonococcus . When this DNA (pSY2) was isolated from Escherichia coli, it was able to transform a variety of gonococcal strains to resistance to nalidixic acid via DNA-mediated transformation, irrespective of their restriction-modification phenotype . Nalidixic acid resistant transformants contained no plasmid DNA sequences that corresponded to the vector, as measured by plasmid screening procedures and colony hybridization techniques . Supercoiled and linear DNA transformed the gonococcus at the same efficiency . DNA fragments as small as 615 bp were able to transform the gonococcus . The presence of a 10-bp uptake sequence enhanced a DNA fragment's ability to transform the gonococcus by four orders of magnitude . When the fragment encoding the nalidixic acid resistant DNA gyrase was subcloned into M13mp18, both the replicative form and the single-stranded form of the phage were able to transform the gonococcus to nalidixic acid resistance.

Pediatr Neurol, 1991 May-Jun, 7(3), 226 - 8
Rhabdomyolysis in children: a 3-year retrospective study; Chamberlain MC; The case reports of 4 pediatric patients illustrate the complex clinical scenarios in which childhood rhabdomyolysis/myoglobinuria occurs . Children ranged in age from 8-18 years . Presumed etiologies of rhabdomyolysis/myoglobinuria included Neisseria sepsis, exertion-related episodes, dialysis disequilibrium, and diabetic ketoacidosis . No child developed respiratory or renal failure . all children were discharged with normal muscle power, indicating the benign nature of this disease and the importance of aggressive management.

Eur J Clin Microbiol Infect Dis, 1991 May, 10(5), 405 - 9
Characterization of Neisseria meningitidis serogroup A strains from an outbreak in France by serotype, serosubtype, multilocus enzyme genotype and outer membrane protein pattern; Riou JY et al.; In an attempt to determine the epidemiological relationship between cases of infection caused by Neisseria meningitidis serogroup A in France between August 1987 and December 1988, and an outbreak which occurred in Mecca in August 1987, markers such as serotype, serosubtype, multilocus enzyme genotype and outer membrane protein (OMP) pattern were used to characterize the bacterial isolates . From a total of 28 cases, 20 strains were isolated . Sixteen isolates, including one which undoubtedly originated from the Mecca epidemic, were homogenous (serotype 4, serosubtype P1.9, multilocus enzyme genotype of clone III-1, identical OMP pattern) . Four isolates had a different OMP pattern with little or no P1 protein, no P4 and no P6 . Two of these isolates belonged to other clones (I.1 and group I) and they were considered to be unrelated to the Mecca epidemic strains . The origin of the remaining two isolates was not clear . It is concluded that the majority of the Neisseria meningitidis serogroup A strains recently isolated in France originate from the Mecca epidemic.

J Clin Microbiol, 1991 May, 29(5), 883 - 8
Comparison of Gen-Probe DNA probe test and culture for the detection of Neisseria gonorrhoeae in endocervical specimens; Panke ES et al.; A 2-h nonisotopic DNA probe assay for the direct detection of Neisseria gonorrhoeae in urogenital specimens has recently been modified (PACE 2; Gen-Probe, San Diego, Calif.) . The new assay format was developed to increase the sensitivity of the assay and simplify procedural steps . In this study, the new DNA probe test was compared with a culture reference method for the detection of N . gonorrhoeae in endocervical specimens . The results of the DNA probe test were expressed as a ratio of relative light units (RLU) of the specimen/RLU of the cutoff recommended by the manufacturer . All patient samples with sample RLU/cutoff RLU ratios less than 0.7 were interpreted as negative, and ratios greater than 2.0 were interpreted as positive for gonorrhea . Samples with sample RLU/cutoff RLU ratios between 0.7 and 2.0 were repeated until two or more consistent negative or positive ratios were obtained . A total of 469 specimens were tested with an overall disease prevalence of 6.1% . Of the 469 patients tested, 5 specimens (1.0%) fell in this borderline region and were retested . If the manufacturer's recommended cutoff value had been used, the original DNA probe results would have resulted in two false-positives . Our data were analyzed for both symptomatic (prevalence, 11.7%) and asymptomatic (prevalence, 2%) women . The study indicated that with our modification of the manufacturer's endpoint interpretation, the DNA probe test was essentially equivalent to the culture method in terms of sensitivity, specificity, and positive and negative predictive values in both symptomatic and asymptomatic patient populations . The new DNA probe test can serve as a suitable screening and diagnostic test for the diagnosis of gonorrheal genital infections in women . Additionally, it offers the advantages of rapid turnaround time and ease of use and allows simultaneous testing for Chlamydia trachomatis on the same specimen.

Infect Immun, 1991 May, 59(5), 1818 - 22
Synthetic peptide substrates for the immunoglobulin A1 protease from Neisseria gonorrhoeae (type 2); Wood SG et al.; Neisseria gonorrhoeae secretes protease which inactive human immunoglobulin A1 (IgA1) by cleavage of specific peptide bonds in the hinge region . The type 2 IgA1 protease (EC 3.4.24.13) is secreted as a 169-kDa precursor which undergoes autoproteolysis at three sites (A, B, and C) to release the 106-kDa active form of the enzyme (J . Pohlner, R . Halter, K . Beyreuther, and T . F . Meyer . Nature {London} 325:458-462, 1987) . Synthetic decapeptides consisting of five residues on each side of the three autoproteolytic cleavage sites and their potential pentapeptide catabolites were prepared by solid-phase synthesis . Cleavage of the decapeptides by the type 2 IgA1 protease from N . gonorrhoeae was monitored by high-performance liquid chromatography . Peptides homologous with the amino acid sequences around the B and C sites are cleaved by the IgA1 protease . Amino acid analysis and Edman degradation show that the cleavage products have both the composition and amino acid sequence which would be expected from cleavage at the predicted sites . Km values of 1.35 mM and 3.43 mM and kcat values of 280 pmol/h/U and 439 pmol/h/U for the site B and site C peptides, respectively, were determined . The catalytic efficiency (kcat/Km) for the synthetic substrates is about 10% of that reported for intact IgA1 . Cleavage of the peptides is inhibited by IgA1 protease inhibitors such as the tetrapeptide substrate analog inhibitor HRP-48, human colostrum, and a peptide-boronate transition state inhibitor . An extract from an N . gonorrhoeae construct lacking active IgA1 protease failed to cleave the synthetic substrate, while an extract from the control construct which secretes active enzyme completely hydrolyzed the synthetic peptide . Neither the site A peptide nor synthetic decapeptides encompassing cleavage sites in the hinge region of IgA1 are hydrolyzed by IgA1 protease . These are the first synthetic substrates to be reported for any IgA1 protease.

Eur J Clin Microbiol Infect Dis, 1991 May, 10(5), 443 - 6
Selective medium for isolation of Arcanobacterium haemolyticum and Streptococcus pyogenes; Wat LL et al.; Sheep blood agar using tryptic soy agar base and containing 3.5% sodium chloride was found to facilitate isolation of Arcanobacterium haemolyticum and improve isolation of Voges-Proskauer negative group A (Streptococcus pyogenes) and group C and G beta-haemolytic streptococci . Commensal oropharyngeal flora such as viridans streptococci, Neisseria species, non-haemolytic streptococci and beta-haemolytic streptococci not belonging to groups A, B, C or G were significantly inhibited.

Klin Padiatr, 1991 May-Jun, 203(3), 158 - 61
{Tumor necrosis factor in the serum--a useful supplemental parameter in the diagnosis of infection in cystic fibrosis?}; Heininger U et al.; In 15 patients with cystic fibrosis 18 blood samples were investigated for signs of infection including full white blood count, c-reactive protein (CRP) and tumour-necrosis-factor alpha (TNF) . Ten patients were hospitalized for pulmonary exacerbation, one for orthostatic collapse and one for equivalent of meconium ileus . The latter two as well as three out-patients with cystic fibrosis on routine-visits served as controls . Blood was taken on admission and at the time of the visit in our out-patient department, respectively . In three cases, blood was taken repeatedly during their stays in hospital . While leucocytosis (17.700 +/- 3.500) and elevated CRP-levels (6.4 +/- 7.3 mg/dl) pointed to an infectious cause of deterioration in the exacerbation-group, TNF-levels without exception were undetectable (less than 15 pg/ml) . In the control group, leucocyte counts (10.700 +/- 3.600) and CRP-levels (1.2 +/- 1.1 mg/dl) showed minor pathologic results . TNF-levels were undetectable, too . While elevated TNF-levels measured quantitatively in patients with invasive bacterial infections, e.g . septicaemia due to Neisseria meningitidis, correlate well with prognosis of disease, in patients with cystic fibrosis such a relationship can't be found.

J Med Microbiol, 1991 May, 34(5), 285 - 93
Stimulation by gonococci of chloride ion uptake in human leucocytes in relation to other properties of phagocytosis; Sukhan A et al.; Human polymorphonuclear leucocytes (PMNL) underwent several changes in response to challenge with Neisseria gonorrhoeae, namely (1) an increase in oxygen uptake, (2) changes in membrane electrical properties, and (3) increased transport of chloride ions (Cl-) across the membrane . Mean oxygen consumption and Cl- uptake by PMNL were stimulated by both pilate (P+) and non-pilate (P-) gonococci, although the levels were much reduced in the presence of P+ organisms . P+ gonococci also initiated low levels of polarisation or depolarisation in contrast with P- cells, which caused hyperpolarisation followed by depolarisation in the PMNL . Most of the strains showed these patterns . High performance liquid chromatography of extracts of unstimulated PMNL and of PMNL challenged with gonococci confirmed production of hypochlorous acid (HOCl) in the leucocyte . Furthermore, addition of radiolabelled Cl- to the PMNLs showed that some of the Cl- taken up by the cells in response to gonococcal challenge was incorporated into the HOCl, suggesting a direct relationship between stimulation of Cl- uptake and production of active chlorine compounds in the leucocyte.

Am Fam Physician, 1991 May, 43(5), 1725 - 32
Clinical aspects of pelvic inflammatory disease; Morgan RJ; Pelvic inflammatory disease is caused by spread of organisms from the vagina and cervix to the upper genital tract . The patient may have a life-threatening illness or may remain asymptomatic . The disease may be caused by sexually or nonsexually transmitted organisms . Polymicrobial infections are the rule . Therapy requires antibiotic agents with broad coverage of aerobic and anaerobic organisms, including Chlamydia trachomatis and Neisseria gonorrhoeae.

Am J Obstet Gynecol, 1991 May, 164(5 Pt 2), 1370 - 6
Diagnosis and laparoscopic grading of acute salpingitis; Soper DE; Pelvic inflammatory disease continues to be a major cause of morbidity in women of reproductive age . Findings of bilateral adnexal tenderness and signs of a lower genital tract infection (mucopus, or leukorrhea, or both) should prompt clinicians to consider the diagnosis of salpingitis in this group of women . Additional signs of infection, such as elevated temperature, palpable adnexal complex, leukocytosis, elevated erythrocyte sedimentation rate, or c-reactive protein, and positive tests for either Neisseria gonorrhoeae or Chlamydia trachomatis will improve the overall specificity of the clinical diagnosis . Endometrial biopsy offers an acceptable approach to documenting objectively inflammation of the upper genital tract . Diagnostic laparoscopy should be considered in all patients but may be especially helpful for those patients in whom a diagnosis is unclear . A laparoscopic grading system based primarily on tubal mobility and inflammation can be useful in predicting duration of in-hospital therapy and future tubal factor infertility.

Rev Sanid Hig Publica (Madr), 1991 May-Jun, 65(3), 247 - 58
{Age and sex distribution of sexually transmitted diseases in Valladolid . A study of 5076 cases}; Orduna Domingo A et al.; The age and sex distribution of 5,076 cases of S.T.D . dealt with between 1982 and 1988 at the Dermatological Dispensary of the Territorial Social Welfare Service in Valladolid are studied . The maximum frequency of S.T.D . (24.1% of cases) corresponded to the age group between 21 and 25 years, which was also the period for maximum prevalence of Neisseria gonorrhoeae (26.3%), Gardnerella vaginalis (30.7%), Candida albicans (27.4%) and acuminata condyloma (33.4%) . Syphilis (19.9%), Chlamydia trachomatis (27%), Ureaplasma urealyticum (24.6%), Mycoplasma hominis (25.0%), Trichomonas vaginalis (23.0%) and genital herpes had maximum prevalence in the group between 26 and 30 years . Women were affected at younger ages than males . 16.9% of women with some S.T.D . were between 16 and 20 years of age, while only 6.5% of males with S.T.D . were in this age-group (p less than 0.001).

Microb Pathog, 1991 May, 10(5), 373 - 84
Effect of human chorionic gonadotropin (hCG) on Neisseria gonorrhoeae invasion of and IgA secretion by human fallopian tube mucosa; Gorby GL et al.; The possible effect of human chorionic gonadotropin (hCG) on the mucosal immune response and susceptibility of the fallopian tube mucosa to invasion by Neisseria gonorrhoeae (gonococci) was investigated in the fallopian tube organ culture (FTOC) model . Immunohistochemical and radioreceptor assay techniques showed specific high affinity binding of hCG in vitro to the apices of non-ciliated fallopian tube cells (Kd approximately 10(-9) M) . Continuous exposure of the FTOC mucosa to hCG during infection with gonococci resulted in a marked increase (6- to 15-fold) in IgA secretion and significantly reduced gonococcal invasion (invasion score range 0.7 to 1.75) compared to infected control tissue which was not exposed to hCG (invasion score range 2.9 to 4.95, P less than or equal to 0.01) . By contrast, exposure of the mucosa to hCG during the 24 h preceding gonococcal infection followed by the removal of hCG from the system at the time of infection resulted in enhanced gonococcal invasion (invasion score range 7.95 to 9.7, P less than 0.001) . We conclude that hCG can modulate the mucosal immune response and susceptibility of fallopian tube epithelium to gonococcal invasion.

J Clin Pathol, 1991 May, 44(5), 376 - 9
Identification of Neisseria gonorrhoeae using the Neisstrip rapid enzyme detection test; Dealler SF et al.; A rapid enzyme activity strip test (Neisstrip, Lab M Ltd, Bury) was compared retrospectively with Phadebact Monoclonal GC coagglutination (Pharmacia Diagnostics, Uppsala, Sweden), cystine trypticase agar sugar utilisation (CTA), and Gonochek II (J W Turner, Liverpool) enzyme methods for identification of 95 Neisseria spp and related species . These had been previously identified using standard methods and included 29 that had given aberrant results . Neisstrip identified correctly all but two, including nine incorrectly identified by Phadebact and 18 erroneously identified using CTA sugars . Results were similar to those obtained with Gonochek II . After this a prospective study was performed testing 400 oxidase positive isolates derived from clinical samples cultured on gonococcal selective medium . Two organisms, both Moraxella spp, were incorrectly identified as N gonorrhoeae by the Neisstrip . The superoxol test, when used with either the Phadebact or Neisstrip tests, maintained 100% sensitivity and specificity . The Neisstrip is a rapid, economic test that is accurate and easy to interpret . It may be used alone or in conjunction with a superoxol test or a coagglutination test, which is relatively accurate but more expensive, and found by some technical staff to be more difficult to interpret.

J Med Microbiol, 1991 May, 34(5), 265 - 70
An epidemiologically valuable typing method for Neisseria meningitidis by analysis of restriction fragment length polymorphisms; Fox AJ et al.; A restriction fragment length polymorphism (RFLP) typing method was developed for Neisseria meningitidis . A cloned EcoRI fragment from a Neisseria meningitidis Group B serotype 15P1.16 sulphonamide-resistant strain was used to probe Southern blots of total chromosomal DNA restriction fragments (enzyme AvaI) . A group of 75 apparently unrelated organisms gave rise to 26 different restriction fragment length patterns and two different groups of epidemiologically related strains had RFLP patterns that were distinct for each group . The technique was highly reproducible and discriminatory . The RFLP data were compared with the results of serotyping and subtyping and isoenzyme electrophoretotyping . The RFLP data were consistent with those from the alternative typing methods; clones defined by isoenzyme analysis were subdivided by this technique . The use of RFLP typing by cloned probes should be of considerable epidemiological value.

Proc Natl Acad Sci U S A, 1991 Apr 15, 88(8), 3281 - 5
Product of the Pseudomonas aeruginosa gene pilD is a prepilin leader peptidase; Nunn DN et al.; The related type IV pilins produced by Pseudomonas aeruginosa, Neisseria gonorrhoeae, Bacteroides nodosus, and Moraxella bovis are synthesized as precursors with short, six- or seven-amino acid N-terminal leader peptides . We have previously observed that P . aeruginosa mutations in pilD, a gene required for pilus biogenesis, result in the accumulation of unprocessed prepilin in the membrane and a general defect in the excretion of a number of extracellular enzymes . An endopeptidase activity has been detected in detergent-solubilized inner membrane of P . aeruginosa and shown to correctly cleave the prepilin of P . aeruginosa and N . gonorrhoeae . It is absent from pilD mutants, increased by pilD overexpression, and conferred on Escherichia coli by the introduction of the pilD gene . The pilD gene product, purified by immunoaffinity chromatography with antibody to a PilD-derived synthetic peptide, was identified with the endopeptidase . PilD appears to be a prototype of a class of enzymes that process not only type IV pilin precursors but also components of a protein-excretion apparatus of Gram-negative bacteria.

Hinyokika Kiyo, 1991 Apr, 37(4), 441 - 6
{A basic study on cefpirome}; Saito I et al.; The antibacterial activity of cefpirome (CPR), a new parenteral cephalosporin antibiotic having a cyclopentenopyridine group in the 3-position side chain, was evaluated against Neisseria gonorrhoeae and concentrations in human kidney and prostate was determined . The minimum inhibitory concentrations (MICs) of CPR against N . gonorrhoeae isolated clinically in our out-clinic (34 strains of non-PPNG and 20 of PPNG) were less than or equal to 0.003-0.1 microgram/ml in non-PPNG group and 0.006-0.1 microgram/ml in PPNG group . The 90% of MICs (MIC90s) was 0.1 microgram/ml in the non-PPNG group and 0.05 microgram/ml in the PPNG group . The concentration in the prostate was determined in 30 cases with benign prostatic hypertrophy . The maximum values was 52.8 micrograms/g at 15 minutes after administration of 1 g of CPR . The levels of CPR were gradually decreased with the lapse of time . The prostatic tissue concentration was 17.9 micrograms/g at 60 min., 10.1 micrograms/g at 180 min., 7.22 micrograms/g at 320 min . and 2.70 micrograms/g at 360 min . There was a positive correlation between concentration of the prostate and plasma collected at the time of the prostate . The concentration of CPR in human kidney, 90-100 min . after administration of 1 g to 4 cases with renal tumor, was 107-148 micrograms/g in the renal cortex, and 80.6-88.6 micrograms/g in the renal medulla . The concentration in kidney was higher than that in the plasma in all cases . In conclusion, CPR is suggested to be a useful drug for urological infection.

Sex Transm Dis, 1991 Apr-Jun, 18(2), 80 - 3
Bacteriologic studies on Neisseria gonorrhoeae isolated in Sapporo, Japan: investigation of beta-lactamase production and auxotypes; Nishimura M et al.; The authors studied the annual incidence of isolation of penicillinase-producing Neisseria gonorrhoeae (PPNG) strains among the total number of strains of N . gonorrhoeae (1,401 strains) that were isolated in Sapporo, Japan during 1980-1989 . During the first half of the 1980s, there was a tendency for PPNG to increase, and the peak incidence was 23.9% in 1985 . Thereafter, the incidence of PPNG decreased to an isolation rate of 6.3% in 1989 . In addition, the auxotypes of 592 of 1,401 isolated strains of Neisseria gonorrhoeae were studied during three periods: 1980-1985, 1986-1987, and 1988-1989 . Among the 592 strains, 315 strains were tested for sensitivity to the action of amoxicillin . In the 1988-1989 period, the auxotype showed an increasing incidence of the auxotype that requires arginine, hypoxanthine, and uracil (i.e., AHU), whereas the proto- and pro-types decreased in incidence . The AHU strains showed higher sensitivity to amoxicillin administration compared with the proto- and pro-strains.

Mol Microbiol, 1991 Apr, 5(4), 917 - 26
L-pilin variants of Neisseria gonorrhoeae MS11; Manning PA et al.; Phase- and antigenic variation of pilin expression in Neisseria gonorrhoeae is based on the genetic exchange between silent pilin genes (pilS) and the pilin expression locus (pilE) . Similarly, the non-piliated L-variants of strain MS11, which show an increased resistance to certain antibiotics, are the result of recombination with the pilE locus . However, this recombination is atypical in that pilE(L) carries a tandem arrangement of a complete pilin gene and additional partial pilin genes under the control of the same pilE promoter . Since the two pilin gene copies are tandemly arranged and are often in the same translational frame, oversized pilin molecules are produced, which do not assemble into pili . The tandem gene copies introduced in a pilE(L) locus originate from silent loci where they are already joint . Upon reversion to the P+ phenotype the L-variants lose one pilin gene copy from the pilE(L) in a process reminiscent of the deletion events that otherwise lead to the formation of the non-revertible and non-piliated Pn mutants of MS11 gonococci . Thus deletion of pilin genes from pilE can be regarded as a third mechanism of pilin variation in gonococci.

Antimicrob Agents Chemother, 1991 Apr, 35(4), 622 - 6
Characterization of a gyrB mutation responsible for low-level nalidixic acid resistance in Neisseria gonorrhoeae; Stein DC et al.; Nalidixic acid-resistant derivatives of Neisseria gonorrhoeae WR302 were identified and categorized into two classes on the basis of their susceptibilities to this antimicrobial agent . The MIC of nalidixic acid for the derivative strain MUG116 was fourfold greater than that for its isogenic parental strain WR302 (2 versus 0.5 micrograms/ml, respectively) . MUG324 was significantly more resistant to nalidixic acid (greater than 64 micrograms/ml) . The MICs of other antimicrobial agents known to interact with either the gyrA or gyrB gene products were determined . Although the nalidixic acid MIC for MUG116 increased, no significant increases in the MICs of other agents that interact with the gyrA gene product were seen . The MICs of all agents that interact with the gyrA gene product were significantly increased for MUG324 . The gene that imparts low-level nalidixic acid resistance was cloned from strain MUG116 . The DNA sequence of this gene was determined, and by comparing the deduced amino acid sequence with sequences of proteins in data bases, this protein was found to be approximately 70% homologous with the gyrB gene product of Escherichia coli.

Zhonghua Liu Xing Bing Xue Za Zhi, 1991 Apr, 12(2), 65 - 8
{Method of multilocus enzyme electrophoresis for typing Neisseria meningitidis serogroup A in China and it's significance in epidemiology}; Wang J; A new, more perfect taxonomic method the multilocus enzyme electrophoresis has recently been developed to type Neisseria meningitidise serogroup A strains in China isolated from 1956-1987 and to study the epidemiological relationship of the types . 183 strains could be divided into 24 ET types, among which ETs, ET18 were found predominant in epidemics occurred in last two decades respectively . Different predominant ET types were found in different epidemic period and only one predominant ET type existed in each period . The cases and carriers occurred in the interepidemic stage and in some places . Their strains belonged to some endemic ET types.

Genitourin Med, 1991 Apr, 67(2), 107 - 13
The epidemiology of Neisseria gonorrhoeae isolates in Dakar, Sénégal 1982-1986: antimicrobial resistance, auxotypes and plasmid profiles; Lind I et al.; A total of 460 Neisseria gonorrhoeae isolates from patients seen at three clinics in Dakar, Senegal, 1982-1986, have been investigated . In this period a significant change in antimicrobial susceptibility was observed: the percentage of strains susceptible to penicillin (MIC less than or equal to 0.08 micrograms/ml) fell from 61 to 18 (p less than 0.0001) and the percentage of resistant strains (MIC greater than or equal to 1.2 micrograms/ml) increased from 18 to 46 . Among penicillin-resistant strains the proportion of penicillinase-producing strains (PPNG) was fairly constant (range 35-55%) . The determination of susceptibility to anti-microbial agents performed locally allowed detection of approximately all PPNG strains whereas the increase in the occurrence of strains with chromosomally determined resistance was not revealed . The study comprised 70 PPNG strains of which 19% (13/70) carried the 7.4 kb Asian plasmid and 81% (57/70) the 5.3 kb African plasmid . None of these strains possessed the 38 kb conjugative plasmid, whereas it was found in 4.5% of the 376 non-PPNG strains available for plasmid analysis; 92% (410/446) of all strains had the small 4.2 kb plasmid and 5.4% (24/446) did not contain any plasmid . Overall, auxotype zero and proline-requiring strains were predominant, accounting for 53% (244/460) and 28% (131/460), respectively . In general, PPNG strains carrying the 5.3 kb plasmid were auxotype zero (49/57 = 86%) and those carrying the 7.4 kb plasmid were proline-requiring (9/13 = 69%).

Ann Emerg Med, 1991 Apr, 20(4), 351 - 4
An evaluation of clinical variables in determining the need for pelvic examination in the emergency department; Levitt MA; STUDY OBJECTIVE: To evaluate the ability of multiple clinical variables to predict an increased or decreased probability of pelvic pathology, therefore determining when a pelvic examination is needed . DESIGN: Cross-sectional . SETTING: An urban emergency department . TYPE OF PARTICIPANTS: 246 female patients presenting with abdominal pain and undergoing pelvic examination . MEASUREMENTS AND MAIN RESULTS: The patients were divided into two groups . Group 1 consisted of 99 patients without pelvic pathology (40%) and group 2 consisted of 147 patients with pelvic pathology (60%) . Pelvic pathology was defined as presence of infective discharge (with confirmation on wet mount/potassium hydroxide smear), presence of adnexal mass and/or tenderness, cervical motion tenderness, uterine enlargement and/or tenderness, blood in the vaginal vault, and culture report positive for Neisseria gonorrhea . The following variables achieved statistical significance (P less than .05) using a logistic regression model: history of vaginal discharge (odds ratio, 2.30 {95% confidence interval, 1.23 to 4.32}); history of dysmenorrhea/menorrhagia (4.35 {1.52 to 12.40}); right upper quadrant pain on physical examination (0.33 {0.13 to 0.85}); and left lower quadrant pain on physical examination or history (1.73 {0.94 to 3.19}) . CONCLUSION: History of vaginal discharge, history of dysmenorrhea/menorrhagia, and left lower quadrant pain on physical examination act as risk variables predicting presence of pelvic disease . Right upper quadrant pain on physical examination acts as a protective variable to predict absence of pelvic disease . This information may aid the emergency physician in determining the need for a pelvic examination in women with abdominal pain.

Sex Transm Dis, 1991 Apr-Jun, 18(2), 119 - 23
Comparison of cefotetan plus doxycycline with cefoxitin plus doxycycline in the inpatient treatment of acute salpingitis; Walker CK et al.; Pelvic inflammatory disease (PID), one of the major sequelae of the current epidemic of sexually transmitted diseases, has been shown to be a polymicrobial infection . This study compares the efficacy and safety of two broad-spectrum combination drug regimens, cefotetan with doxycycline and cefoxitin with doxycycline, in the treatment of PID . A total of 108 patients with acute salpingitis were hospitalized and randomized into two treatment groups: cefotetan/doxycycline (N = 54) and cefoxitin/doxycycline (N = 54) . Before antibiotic administration, Chlamydia trachomatis was identified in 17 (16%) of the patients, Neisseria gonorrhoeae from 72 (67%), and anaerobic and aerobic bacteria were identified from the endometrial cultures of 86 (80%) . There were seven tubo-ovarian abscesses (TOAs) that were diagnosed in the cefotetan group, and six in the cefoxitin group . Clinical cure was achieved in 51 of 54 (94%) patients in each group . Of the six patients whose treatment failed, all had positive cultures for N . gonorrhoeae and facultative/anaerobic bacteria, whereas none had C . trachomatis . Two patients from each study arm whose treatment failed were diagnosed with TOAs and responded subsequently to clindamycin plus an aminoglycoside . Cultures that were obtained after the completion of inpatient treatment showed the eradication of C . trachomatis and N . gonorrhoeae in all patients . Also, both regimens were effective in reducing aerobic and anaerobic pathogens . Finally, both regimens were well tolerated, with few side-effects.

J Bacteriol, 1991 Apr, 173(7), 2147 - 54
Transposition of Tn1545-delta 3 in the pathogenic Neisseriae: a genetic tool for mutagenesis; Nassif X et al.; The ability to study the virulence of pathogenic Neisseria spp . has been greatly limited by the absence of genetic tools which allow the construction of defined mutants . We have engineered a transposon system which allows random mutagenesis of the Neisseria genome at relatively high frequency . Tn1545-delta 3 is a 3.4-kb derivative of the gram-positive transposon Tn1545 encoding resistance to kanamycin . Tn1545-delta 3 was subcloned into an erythromycin-resistant derivative of the mobilizable shuttle vector pLES2 to yield the plasmid pMGC20 . This latter plasmid was introduced by conjugation from Escherichia coli S17-1 into Neisseria meningitidis 8013N and Neisseria gonorrhoeae 15063G . Kanamycin-resistant 8013N and 15063G transconjugants appeared at frequencies of 10(-5) and 10(-6), respectively . Restriction enzyme analysis and Southern blot hybridization of these transconjugants showed that, in Neisseria spp., the transposon excised spontaneously from pMGC20 and integrated into chromosomal DNA . Our studies revealed that (i) transposition of Tn1545-delta 3 was in numerous, apparently distinct sites, (ii) in most cases, for each transconjugant a single copy of Tn1545-delta 3 was integrated into the chromosome, and (iii) several passages on selective media did not induce secondary transposition . The kanamycin resistance marker expressed by the transconjugants was subsequently transformed into a parental background without change in the chromosomal location of the transposon . To assess the role of the general recombination system in the transposition of Tn1545-delta 3, the recA gene of N . meningitidis has been cloned and a rec derivative of 8013N has been engineered . Similar results were obtained when this latter strain was used as recipient, suggesting that recA function were not required for Tn1545-delta 3 transposition in N . meningitidis . Transposition with Tn1545-delta 3 may be an important technique for mutagenesis of the pathogenic neisseriae.

Microb Pathog, 1991 Apr, 10(4), 323 - 32
Neisseria gonorrhoeae LPS variation, serum resistance and its induction by cytidine 5'-monophospho-N-acetylneuraminic acid; Demarco de Hormaeche R et al.; Inherent serum resistance and the effect of the serum resistance inducing factor cytidine 5'-monophospho-N-acetylneuraminic acid (CMP-NANA) were studied on Neisseria gonorrhoeae with different lipopolysaccharides (LPS) . Strain M01 and LPS variants of strain Gc40 (variants D1, D2, D4 and D5) were examined after incubation in the presence or absence of CMP-NANA by bactericidal assays using normal human or immune sera and by SDS-PAGE followed by silver staining or Western blotting . The blots were probed with monoclonal antibody CC1, specific to epitope C of the LPS . Variants D1 and D5 were inherently serum resistant, variants D2 and D4 and strain M01 were susceptible . CMP-NANA induced marked changes in the LPS of all gonococci . However, only some gonococci were converted to serum resistance . Gonococci which were converted to serum resistance had LPS with components of relatively large molecular mass, expressing epitope C . Variants which did not convert to serum resistance had LPS with low molecular mass components only, without epitope C . Conversion to serum resistance increased the size of the large LPS components without affecting the expression of epitope C . The results indicate that conversion to serum resistance by CMP-NANA is not a general occurrence but depends on the quality of the LPS.

CMAJ, 1991 Mar 15, 144(6), 713 - 21
Predictors of chlamydial infection and gonorrhea among patients seen by private practitioners; Vincelette J et al.; OBJECTIVE: To identify the predictors of chlamydial infection and gonorrhea among patients tested by general practitioners . DESIGN: Prospective study . SETTING: General private practice, family planning and abortion clinic, adolescent clinic, sexually transmitted disease (STD) clinic and community health clinic in downtown Montreal . PATIENTS: The 2856 patients were included because of symptoms compatible with an STD, a history of sexual contact with a person known or suspected to have chlamydial infection, a history of a nonexclusive sexual relationship or presentation for an abortion . MEASURES: Patient information was obtained by the attending physician on a standard form . Enzyme immunoassay (EIA) for Chlamydia trachomatis and culture for Neisseria gonorrhoeae were performed on cervical (female) or urethral (male) samples . Stepwise logistic regression was used to identify the predictors of infection . RESULTS: The EIA results were positive in 11.1% of the cases and the culture results in 2.3% . Among the males chlamydial infection was independently associated with low age (odds ratio {OR} = 0.88 per year), heterosexuality (OR = 4.99), urethral discharge (OR = 3.74) and the absence of a history of gonorrhea (OR = 0.51) . Gonorrhea was associated with urethral discharge (OR = 24.3) and homosexuality (OR = 3.68) . Among the females chlamydial infection was associated with low age (OR = 0.79 per year), a history of sexual contact with a person known to have chlamydial infection (OR = 2.30), multiple sexual partners in the previous 12 months (OR = 1.60) and a reason for the test other than screening purposes (OR = 0.60) . Gonorrhea was associated with a reason other than screening (OR = 0.24) and low age (OR = 0.74 per year) . Among the patients tested for screening purposes age was the only significant predictor of chlamydial infection (OR = 0.79 per year), and the prevalence of gonorrhea was 0.4% . The actual rate of chlamydial infection was 11.8% among the patients younger than 25 years, 5.7% among those 25 to 34 years and 0.6% among those over 34 . CONCLUSIONS: Age alone can be used as a criterion to screen for chlamydial infection among asymptomatic patients without a history of sexual contact with a person known or suspected to have such infection and with a history of a nonexclusive relationship . The prevalence in our population justifies screening people up to 34 years of age.

Immunol Today, 1991 Mar, 12(3), A29 - 33
Molecular genetics of antigenic variation; Borst P; Antigenic variation is one of the most effective strategies developed by parasites to escape immune destruction . It requires a large wardrobe of surface coats and mechanisms to exchange one coat for an unrelated one . The molecular principles of antigenic variation are now largely known in the bacterial species Borrelia and Neisseria and in the protozoa of the African trypanosome group and these three examples are discussed here by Piet Borst.

Rev Infect Dis, 1991 Mar-Apr, 13(2), 216 - 8
Neisseria lactamica meningitis following skull trauma; Denning DW et al.; A woman developed meningitis due to Neisseria lactamica in association with a cribriform plate fracture . Cerebrospinal fluid antigen tests for Neisseria meningitidis were negative . The patient recovered with intravenous penicillin therapy . N . lactamica can be rapidly distinguished from N . meningitidis by the hydrolysis of ONPG (o-nitrophenyl-beta-D-galactopyranoside) . In contrast to N . meningitidis and Neisseria gonorrhoeae, N . lactamica lacks virulence properties . As 100% of N . lactamica strains are susceptible to penicillin and all three previously described patients with N . lactamica meningitis have recovered with penicillin treatment, the reason for distinguishing the organisms in this context is primarily to prevent unnecessary anxiety and prophylaxis among contacts.

Clin Exp Immunol, 1991 Mar, 83(3), 430 - 7
Functionally active complement proteins C6 and C7 detected in C6- and C7-deficient individuals; Wurzner R et al.; Two sensitive sandwich ELISAs based on monoclonal antibodies directed to native C6 and C7 allowed the detection and quantitation of these complement proteins in 20 out of 37 serum samples from individuals who had previously been classified as deficient in these proteins as assessed by immunochemical and/or functional assays . Furthermore, serum from four C6-deficient and one combined C6-/C7-deficient individual showed an increase in the terminal complement complex (TCC) and a decrease in native C6 and C7 after complement activation as assayed by specific ELISAs . Despite their (incomplete) deficiencies, these individuals therefore possess functionally active terminal complement proteins with respect to their ability to generate the TCC . As these individuals have no history of a susceptibility to neisserial infections, even low concentrations of functionally active C6 and C7 may provide sufficient protection against those micro-organisms whose destruction requires TCC formation.

Am J Obstet Gynecol, 1991 Mar, 164(3), 734 - 42
A randomized placebo-controlled trial of erythromycin for the treatment of Ureaplasma urealyticum to prevent premature delivery . The Vaginal Infections and Prematurity Study Group; Eschenbach DA et al.; Ureaplasma urealyticum has been associated with low birth weight and histologic chorioamnionitis and it is a frequent isolate from the chorioamnion of patients who are delivered prematurely . In prior clinical trials using antibiotics active against U . urealyticum, antibiotic treatment was associated with reduced prematurity and increased mean birth weight . In this multicenter, randomized, double-blind clinical trial, pregnant women with U . urealyticum were treated with 333 mg of erythromycin base or placebo three times daily, starting between 26 and 30 weeks' gestation and continuing through 35 completed weeks of pregnancy . Women with urinary tract infection or Neisseria gonorrhoeae infection were excluded from the trial, and women with Chlamydia trachomatis or group B streptococci were excluded from these analyses . Erythromycin did not eliminate U . urealyticum from the lower genital tract . There were no significant differences between erythromycin- and placebo-treated women in infant birth weight or gestational age at delivery, in frequency of premature rupture of membranes, or in neonatal outcome.

Am J Otolaryngol, 1991 Mar-Apr, 12(2), 113 - 6
Branhamella catarrhalis and croup: toxicity in the upper respiratory tract; Dudley JP; Branhamella catarrhalis has gained increasing recognition as a pathogen in the respiratory tract . During the past 18 years, since its transfer from the genus Neisseria, it has been associated with infection in cavities of the respiratory tract (sinuses and middle ear) . It has been recognized as playing a role in laryngitis . Its isolation in large numbers from the surface and core of acutely and chronically infected tonsils indicates a possible role in these infections . Croup (two patients reported here) can now be added to this list . The toxic potential of B catarrhalis, its movement from commensal to pathogen for the upper respiratory tract, and the pathogenic mechanisms by which this has occurred are reviewed.

Antimicrob Agents Chemother, 1991 Mar, 35(3), 497 - 9
Susceptibility of Neisseria gonorrhoeae to cefpodoxime: determination of MICs and disk diffusion zone diameters; Fekete T et al.; We studied the susceptibilities of 77 strains of Neisseria gonorrhoeae to four antibiotics: cefpodoxime, ceftriaxone, penicillin, and tetracycline . All strains were susceptible to ceftriaxone . Cefpodoxime MICs (range, 0.001 to 0.125 micrograms/ml) were parallel to and approximately four times those of ceftriaxone, and all strains will probably be considered susceptible to cefpodoxime . Disk diffusion zone diameters for cefpodoxime ranged from 35 to 57 mm . Of the strains, 32% were penicillin resistant and 51% were tetracycline resistant (MIC, greater than or equal to 2 micrograms/ml) . Susceptibility measurements were consistent for disk diffusion zone diameter and MIC, with an overall agreement of 215 of 225 (96%) for ceftriaxone, penicillin, and tetracycline combined . On the basis of these in vitro data, cefpodoxime should be evaluated in the treatment of gonorrhea.

J Reprod Med, 1991 Mar, 36(3), 202 - 5
Role of Neisseria gonorrhoeae and Chlamydia trachomatis in intraabdominal abscess formation in the rat; Cox SM et al.; Our concept of the pathogenesis of acute salpingitis and advanced pelvic infection, such as tuboovarian abscess, is evolving . Although Neisseria gonorrhoeae and Chlamydia trachomatis are thought to play a significant role in acute pelvic inflammatory disease, other microorganisms, such as aerobes and anaerobes, have repeatedly been reported to play a significant role, also, particularly in the patient with advanced disease . A study was designed to evaluate the pathogenesis, and particularly any synergistic role, of some aerobes and anaerobes with N gonorrhoeae and C trachomatis abscess formation . Using the rat model developed by Weinstein and Onderdonk, the study demonstrated that N gonorrhoeae and C trachomatis alone do not produce abscesses . However, when combined with facultative or anaerobic bacteria, synergism with abscess formation is noted frequently . The data support the hypothesis that N gonorrhoeae and C trachomatis initiate infection and that aerobic and anaerobic bacteria act synergistically to produce abscesses . In addition, microorganisms not inoculated were found to be recruited into the infectious process . The organisms may gain access to the peritoneal cavity via the lower genital tract or from transmucosal migration from the intestinal flora.

Am J Obstet Gynecol, 1991 Mar, 164(3), 849 - 58
Combination antimicrobial therapy in the treatment of acute pelvic inflammatory disease; Landers DV et al.; We compared the clinical and microbiologic efficacy of two broad-spectrum combination antimicrobial regimens in the treatment of 148 patients with acute pelvic inflammatory disease . Patients were randomized to inpatient treatment with either cefoxitin and doxycycline (n = 75) or clindamycin and tobramycin (n = 73) . These antibiotics were administered intravenously for at least 4 days, and up to 48 hours beyond defervescence . Patients were discharged on a regimen of oral doxycycline or clindamycin in accordance with the intravenous regimen to complete a total duration of therapy of 2 weeks . Neisseria gonorrhoeae (53%) and Chlamydia trachomatis (31%) were the microorganisms that were isolated most frequently from the genital tract of enrolled patients . At follow-up, N . gonorrhoeae was isolated in two patients, and C . trachomatis was isolated in none . The overall initial favorable response rate to combination antimicrobial therapy was 98.5% (130/132) in patients with uncomplicated pelvic inflammatory disease and 81% (13/16) in patients with pelvic inflammatory disease that was complicated by tuboovarian abscess . A greater than 70% decrease in abdominal tenderness score occurred in 89% of 111 patients within 6 weeks of hospital discharge . There were no significant differences between antibiotic treatment groups in any response categories or in toxicity . During the initial hospitalization, five patients (three with tuboovarian abscess; one with a pyosalpinx, and one with intractable acute and chronic pelvic inflammatory disease) required surgical intervention . These results support the recommendation to use broad-spectrum combination antimicrobial therapy for the treatment of acute pelvic inflammatory disease.

Clin Ther, 1991 Mar-Apr, 13(2), 243 - 53
Epidemiology of beta-lactamases in Africa: correlation with resistance to beta-lactam antibiotics; Dowse LJ et al.; In 45 centers from eight African countries, 2,888 bacterial isolates were collected from patients with community-acquired infections . Isolated pathogens included Staphylococcus aureus (29%), Escherichia coli (20%), Neisseria gonorrhoeae (6%), Proteus species (6%), Klebsiella species (6%), Klebsiella pneumoniae (4%), and Staphylococcus epidermidis (4%) . An overall sensitivity of 16.2% was shown to penicillin G (number of isolates tested = 2,467), 31.8% to ampicillin (2,687), 45% to amoxicillin (1,959), and 84.9% to cefuroxime (2,888) . Beta-lactamase presence was measured by a chromogenic method . Beta-lactamase was found in 75% of all pathogens tested, including 69.5% of gram-negative and 83.3% of gram-positive pathogens; 73% of E coli isolates, 76% of N gonorrhoeae, 75% of Klebsiella species, and 84% of S aureus were beta-lactamase positive . Beta-lactamase presence was associated with bacterial resistance for penicillin G, ampicillin, and amoxicillin, but not cefuroxime, whose sensitivity remained high . The higher resistance rates and beta-lactamase prevalence in Africa suggest the need for national antibiotic prescribing policies and surveillance schemes and replacement of relatively ineffective penicillins with newer agents such as cefuroxime.

Prostaglandins Leukot Essent Fatty Acids, 1991 Mar, 42(3), 167 - 9
Prostaglandin production by amnion and decidual cells in response to bacterial products; Mitchell MD et al.; Media from bacterial cultures have been tested for actions on prostaglandin biosynthesis by human amnion and decidual cells . The bacterial species, which are commonly associated with intrauterine infections, were Group B streptococcus, Escherichia coli, Fusobacterium nucleatum, Bacteroides fragilis, Gardnerella vaginalis, Neisseria gonorrhea, Mycoplasma hominis and Ureaplasma urealyticum . Overall, low doses of bacterial products were stimulatory of amnion prostaglandin production, whereas high doses were inhibitory . A similar pattern of results was obtained for effects on decidual prostaglandin production, although stimulatory actions at low doses were less pronounced . In all experiments interleukin 1 beta consistently induced a stimulation of prostaglandin production that greatly exceeded that caused by any bacterial product . It is possible that the inhibitory action of high doses of bacterial products on prostaglandin biosynthesis may contribute to the poor course of labor experienced by women with chorioamnionitis . Furthermore, these data lend credence to the view that the host response to infection (i.e . cytokine secretion) is the major mediator of subsequent preterm labor.

Indian J Med Res, 1991 Mar, 93, 95 - 7
Microbiological evaluation of female patients in STD clinics; Iyer SV et al.; A total of 215 women patients attending the STD clinic were evaluated in an attempt to isolate the different microorganisms in sexually transmitted diseases (STD) . Mycoplasmas (30.22%), Candida species (20.00%), Trichomonas vaginalis (wet mount study; 15.81%), beta haemolytic streptococci (13.48%), Neisseria gonorrhoeae (9.30%), Staphylococcus aureus (13.95%), inclusion bodies of Chlamydia trachomatis (11.60%) and Gram negative organisms (9.30%) were isolated from these patients . Sera of all patients screened for HBsAg by ELISA showed a carrier rate of 12.5 per cent; 29.8 per cent sera were reactive in the VDRL test at the dilutions varying from 1:4 to 1:64PIP: The incidence of 10 sexually transmitted diseases (STDs) in 215 prostitutes attending a STD clinic was determined by culture and other standard techniques . A control group of 100 women attending an outpatient family planning clinic in L.T.M . Medical College, Bombay, matched for age and socioeconomic level was the reference . The organisms assayed, the percent of study group found positive, and the percent of controls found positive were: M . hominis, 11.2 and 0.0%; U . urealyticum, 19.1 and 12.0%; Candida to species level, 20.0 and 70.%; beta-hemolytic streptococci, 13.5 and 3.0%; group B streptococci, 6.7 and 0.0%; T . vaginalis, 15.8 and 3.0%; C . trachomatis (by inclusion bodies), 11.6 and 1.0%; coagulase-positive S . aureus, 13.95 and 5.0%; N . gonorrhoeae, 9.3 and 0.0%; and Gram negative bacteria, 9.3 and 1.0% . The VDRL (Venereal Disease Reference Laboratory) seropositivity was 29.5% in STD patients . HBsAG (hepatitis B surface antigen) were present in 12.5% . Most of the women had vaginitis, cervicitis, vulvitis or warts with secondary infections . These incidence rates were discussed relative to several other Indian surveys .

J Infect Dis, 1991 Mar, 163(3), 460 - 3
Cytomegalovirus infection in sexually active adolescents; Sohn YM et al.; To determine whether cytomegalovirus (CMV) infection in teenage girls is related to sexual activity, 254 girls 12-18 years old (mean, 15.8) attending a contraceptive counseling clinic were studied . Participants were screened for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, and serum antibody to CMV was determined . Demographic and sexual history data were collected by interview . The mean number of lifetime sex partners was 2.2; 173 (68%) were seropositive . Race, greater than 3 years of sexual activity, and greater than 2 lifetime sex partners were significant risk factors for CMV infection (odds ratios {OR}, 1.8-4.7; P less than .05) . Using logistic regression analysis, a composite sexual activity variable was the most important risk factor for CMV infection (OR, 4.8; P = .003), followed by race (OR, 3.4; P = .004) and a sexually transmitted disease composite variable (OR, 2.4; P = .016) . Sexual activity is an important risk factor for CMV infection in adolescent girls.

Clin Exp Immunol, 1991 Mar, 83(3), 413 - 7
Human hybridomas derived from CD5+ B lymphocytes of patients with chronic lymphocytic leukemia (B-CLL) produce multi-specific natural IgM (kappa) antibodies; Jahn S et al.; Great numbers of CD5+ B lymphocytes were detected in the peripheral blood of patients with B-CLL . To study the antibody repertoire of this immune cell subpopulation on a monoclonal level, we fused the lymphocytes derived from five different donors to a highly efficient HAT-sensitive heteromyeloma line (CB-F7) . A fusion frequency of up to 10(-5) allowed us to analyse hundreds of initial hybridoma lines per fusion . In all culture supernatants in three out of five fusions IgM lambda antibodies were detected, in two experiments only IgM kappa was measured, suggesting monoclonality of the primary hybridoma cell lines . The later fusions resulted in hybridomas producing multi-specific antibodies against both an autoantigen and an infectious agent: (i) dsDNA/influenza virus haemagglutinin; (ii) dsDNA/class V outer membrane protein type C from Neisseria meningitidis . However, no antibodies of the described specificity were detected in blood sera of patients, indicating a 'switch-on' of the immunoglobulin secretion capacity of malignant B cells during fusion to a myeloma partner . We discuss the results as further evidence for the natural multi-reactive antibody repertoire of CD5+ B cells.

Antimicrob Agents Chemother, 1991 Feb, 35(2), 300 - 4
Penicillin-resistant isolates of Neisseria lactamica produce altered forms of penicillin-binding protein 2 that arose by interspecies horizontal gene transfer; Lujan R et al.; Isolates of Neisseria lactamica that have increased resistance to penicillin have emerged in recent years . Resistance to penicillin was shown to be due to the production of altered forms of penicillin-binding protein 2 (PBP 2) that have reduced affinity for the antibiotic . The sequences of the PBP 2 genes (penA) from two penicillin-resistant isolates were almost identical (less than or equal to 1% sequence divergence) to that of a penicillin-susceptible isolate, except in a 175-bp region where the resistant and susceptible isolates differed by 27% . The nucleotide sequences of these divergent regions were identical (or almost identical) to the sequence of the corresponding region of the penA gene of N . flavescens NCTC 8263 . Altered forms of PBP 2 with decreased affinity for penicillin in the two penicillin-resistant isolates of N . lactamica appear, therefore, to have arisen by the replacement of part of the N . lactamica penA gene with the corresponding region from the penA gene of N . flavescens.

J Immunol, 1991 Feb 1, 146(3), 1052 - 6
Reduced C8 beta messenger RNA expression in families with hereditary C8 beta deficiency; Warnick PR et al.; Individuals with functional C8 beta deficiency are at increased risk for systemic neisserial infections . Studies by others have shown that the structural gene for this protein appears intact in deficient individuals . We studied affected individuals from 10 unrelated families to determine the basis for their defect . Using chain-specific antisera, C8 beta was undetectable on immunoblots of their sera . The polymerase chain reaction was used to probe cDNA synthesized from RNA isolated from human liver cells, HepG2 cells, peripheral blood monocytes, and fibroblasts to identify a readily available cell source expressing C8 beta message . Cells from each of these sources expressed C8 beta message . The identity of the amplified product was confirmed and this approach was used to probe cDNA synthesized from RNA harvested from monocytes or fibroblasts obtained from two unrelated families with C8 beta deficiency . C8 beta mRNA was readily detectable in C8 beta sufficient and heterozygous family members but required Southern blotting and hybridization to the 32P-labeled C8 beta probe for detection in the homozygous deficient probands . These results suggest that C8 beta-deficient individuals produce less C8 beta-specific mRNA than do normals and that the underlying basis for this deficiency is an abnormality in intracellular events that precede secretion.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Feb, (2), 51 - 4
{A radioimmunological method for determining IgA-class antimeningococcal secretory antibodies in human saliva}; Krasnoproshina LI et al.; The data on the content of secretory IgA antibodies to group A Neisseria meningitidis protein antigen in the saliva of persons, both having had contact with N . meningitidis culture and having had no such contact, are presented . The results were obtained by the method of radioimmunoassay, developed specially for the determination of N . meningitidis protein antigen.

J Clin Pathol, 1991 Feb, 44(2), 169 - 70
Laboratory detection of ciprofloxacin resistant Neisseria gonorrhoeae; Turner A et al.; During 1989 and 1990 strains of Neisseria gonorrhoeae with reduced susceptibility to ciprofloxacin were isolated in laboratories across the United Kingdom . Treatment failures were associated with some of these infections . These strains were detected by quantitative susceptibility testing because the zone of inhibition around 5 micrograms ciprofloxacin discs shows little decrease in size even with those that are the most resistant . This study determined that strains with reduced susceptibility to ciprofloxacin (MIC of greater than or equal to 0.05 mg/l) produced no zone of inhibition around a commercially available disc containing 30 micrograms of nalidixic acid . Ciprofloxacin sensitive (MIC of less than 0.05 mg/l) strains, however, grew with a large zone (greater than 21 mm) around this disc . These observations suggest that laboratories could adopt this disc test to detect those strains for which ciprofloxacin is not appropriate treatment.

Pathol Biol (Paris), 1991 Feb, 39(2), 136 - 9
{In vitro activity of an antiseptic, chlorquinaldol, against Neisseria gonorrhoeae and Chlamydia trachomatis}; Corrihons I et al.; The activity of chlorquinaldol, a derivative of hydroxy-8-quinolein used for local antisepsy, was studied against Neisseria gonorrhoeae and Chlamydia trachomatis . The weak solubility of the product and the special growth conditions of the organisms made an adaptation of the AFNOR norm necessary . For 0.1 to 0.2% (W/V) chlorquinaldol concentrations, a reduction of about 10(4) organisms was obtained after 60 minutes for N . gonorrhoeae and C . trachomatis . However, for technical problems, the concentrations tested were 10 to 100 times lower than the doses usually recommended for this antiseptic.

Mol Cell Probes, 1991 Feb, 5(1), 49 - 54
Evaluation of a DNA probe of plasmid origin for the detection of Neisseria gonorrhoeae in cultures and clinical specimens; Torres MJ et al.; This study evaluates a cryptic plasmid-derived DNA probe in a dot-blot hybridization assay of 4-h duration, using both known bacterial isolates and clinical specimens . The probe, consisting of a 237 bp segment of the plasmid-encoded gene cppB, sequences of which are also found in the chromosome, was labelled with digoxigenin-11-dUTP . The sensitivity of the probe was approximately 25 pg of DNA or 500 cfu of Neisseria gonorrhoeae . A total of 170 reference strains of Neisseria gonorrhoeae and other related bacteria were tested for reactivity with the probe . All N . gonorrhoeae strains, including three plasmid-free strains, hybridized with the probe . Among the heterologous bacterial cultures, only one strain of N . cinerea reacted with the probe when the cell concentration was 5 x 10(6) cfu . The probe was also evaluated in a clinical study . A total of 201 patients visiting the STD clinic at the University Hospital, University of Seville, participated in the study . The sensitivity of the assay was 95% while the specificity was 98% . Positive and negative predictive values were 97% and 98%, respectively . It appears that the plasmid-derived probe used in this study could serve as a useful tool in the rapid and specific detection of Neisseria gonorrhoeae in clinical specimens.

J Clin Microbiol, 1991 Feb, 29(2), 363 - 6
Interpretive criteria and quality control guidelines for Neisseria gonorrhoeae susceptibility test standardization for cefotetan; Jones RN et al.; Cefotetan was tested in a multilaboratory study to standardize susceptibility testing criteria and quality control guidelines for Neisseria gonorrhoeae . Cefotetan was most active against penicillinase-producing and penicillin-susceptible strains (MIC for 50% of strains tested, 0.5 micrograms/ml) and was least active against the chromosomally resistant isolates (MIC for 50% of strains tested, 2 micrograms/ml) . The recommended 30-micrograms disk cefotetan interpretive criteria were as follows: susceptible at greater than or equal to 26 mm (less than or equal to 2 micrograms/ml), intermediate at 20 to 25 mm (4 micrograms/ml), and resistant at less than or equal to 19 mm (greater than or equal to 8 micrograms/ml) . Quality control guidelines for agar dilution and disk diffusion tests were established by using numerous GC agar lots, three cefotetan 30-micrograms disk lots, two quality control organisms, and a volume of tests consistent with National Committee for Clinical Laboratory Standards M23-T guidelines.

Infect Immun, 1991 Feb, 59(2), 732 - 6
Identity between polysaccharide antigens of Moraxella nonliquefaciens, group B Neisseria meningitidis, and Escherichia coli K1 (non-O acetylated); Devi SJ et al.; A surface polysaccharide antigen of Moraxella nonliquefaciens, reported to be cross-reactive with the capsular polysaccharides of group B Neisseria meningitidis and Escherichia coli K1 (K . Blvre, K . Bryn, O . Closs, N . Hagen, and L . O . Froholm, NIPH Ann . 6:65-73, 1983), was isolated, purified, and characterized chemically, immunologically, and by nuclear magnetic resonance . This polysaccharide was shown to be a linear homopolymer of alpha (2----8)-linked N-acetylneuraminic acid, identical to the capsular polysaccharide of group B N . meningitidis and O-acetyl-negative variants of E . coli K1.

Genomics, 1991 Feb, 9(2), 290 - 7
Nonsporulating bacterial species contain DNA sequences homologous to the Bacillus spore-specific C-protein gene; Vocero-Villeta AM et al.; Genes for small, acid-soluble spore proteins (SASPs) are ubiquitous among the spore-forming bacteria and are expressed only during sporulation . Although they perform the function of amino acid storage in spores, the members of the SASP-C multigene family probably serve additional functions, so that similar sequences might be present in non-spore-formers . Using the SASP-C gene (ssp-c) as a hybridization probe, restriction digests of whole genomic DNA from seven nonsporulating bacterial species were examined for similar sequences . Hybridization was found in four species: Streptococcus pyogenes, Staphylococcus aureus, Neisseria sicca, and Mycobacterium phlei, indicating the presence of similar sequences in some, but not all, of the non-spore-formers . In each of these positive species, multiple bands hybridized . A 4.5-kb hybridizing fragment from S . pyogenes and a 9.0-kb hybridizing fragment from M . phlei have been cloned and partially sequenced . These fragments show substantial DNA sequence homology to ssp-c and their deduced amino acid sequences show substantial homology to SASP-C.

Proc Natl Acad Sci U S A, 1991 Feb 1, 88(3), 1029 - 33
FKB1 encodes a nonessential FK 506-binding protein in Saccharomyces cerevisiae and contains regions suggesting homology to the cyclophilins; Wiederrecht G et al.; FK 506, a powerful immunosuppressant that blocks allograft rejection by preventing T-cell activation, binds to an 11-kDa protein called the FK 506-binding protein (FKBP) . Like cyclophilin, a cytosolic protein that binds another immunosuppressant, cyclosporin A, FKBP possesses peptidylprolyl cis-trans isomerase activity . We have isolated a genomic clone encoding the yeast FKBP (FKB1) . The gene encodes a protein of 114 amino acids having a calculated Mr of 12,158 . Disruption of the gene shows that FKB1 is not essential for growth . A search of translated nucleic acid data bases revealed bacterial FKBP homologs in Neisseria meningiditis and Pseudomonas aeruginosa . Comparison of the conserved amino acids in FKBP homologs with the conserved amino acids in the cyclophilins has revealed a region of similarity that we speculate to be a homologous domain related to the functional similarities of the two proteins.

Behring Inst Mitt, 1991 Feb, (88), 194 - 9
Evasion mechanisms of pathogenic Neisseriae; Meyer TF; The outcome of the early stages of a neisserial infection is determined by receptor-mediated events that culminate in the attachment and invasion of human mucosal tissues . The factors participating in this process, including pili, opacity proteins (Opa), and perhaps lipopolysaccharide (LPS), undergo phase and antigenic variation allowing the pathogens to evade the human immune response . In addition antigenic variation is essential in the modulating pathogen host cell interactions . Likewise the production of distinct Opa proteins allows the bacteria to enter epithelial cells and thereby to escape the humoral host responses . Other mechanisms including antigenic mimicry by capsular polysaccharides and antigenic masquerade by immunoglobulin fragments confer additional resistance to the extracellular life style of these organisms . Finally alpha-protein, a putative hormone-like factor produced by pathogenic Neisseriae, may contribute to the complex evasion-program of these species.

Enferm Infecc Microbiol Clin, 1991 Feb, 9(2), 95 - 7
{Multicenter study of the Rosco-Neisseria system for the identification of pathogenic neisserias and Branhamella catarrhalis}; Perez JL et al.; The commercial Rosco-Neisseria system was evaluated in the identification of 228 oxidase-positive Gram-negative diplococci and it was compared with conventional tests . The procedure detects gamma-glutamyl aminopeptidase, ONPG, tributyrin hydrolysis, and sensitivity to the disk of 10 micrograms of colistin . A correct identification was obtained in the 65 strains of Neisseria gonorrhoeae, the 33 of N . meningitidis, the 12 of N . lactamica, and the 56 of B . catarrhalis . The method was also able to discriminate 54 out of the 62 strains of nonpathogenic Neisseria . However, the 7 strains of Neisseria polysaccharea and one strain of N . subflava biovar perflava were erroneously identified as N . gonorrhoeae . None of the latter was superoxol positive in contrast with the 100% of cases of gonococcal strains . The Rosco-Neisseria system is simple and inexpensive but it should be applied on specimens that grow on selective media for gonococci (such as Thayer-Martin and others) and it should be complemented by superoxol test.

Mol Microbiol, 1991 Feb, 5(2), 279 - 87
Pilin expression and processing in pilus mutants of Neisseria gonorrhoeae: critical role of Gly-1 in assembly; Koomey M et al.; Spontaneous mutants of Neisseria gonorrheae failing to express pili or having diminished levels of piliation were studied with regard to pilin expression . All mutants displayed altered pilin processing detectable as the release of soluble, truncated pilin molecules (S-pilin) . Of particular interest was the finding, in one mutant, that substitution of serine for glycine at position -1 of propilin, a highly conserved residue among N-metPhe and related pilins, abolished pilus expression but not S-pilin release . The degree of S-pilin processing and the levels of membrane-associated pilin varied among the different classes of mutants, suggesting that each was blocked at a distinct step of pilus biogenesis . The data support a model in which increased S-pilin processing is a result of a decreased rate of pilus polymerization.

EMBO J, 1991 Feb, 10(2), 477 - 88
Phase variation of gonococcal pili by frameshift mutation in pilC, a novel gene for pilus assembly; Jonsson AB et al.; Pili prepared from Neisseria gonorrhoeae contain minor amounts of a 110 kd outer membrane protein denoted PilC . The corresponding gene exists in two copies, pilC1 and pilC2, in most strains of N.gonorrhoeae . In the piliated strain MS11(P+), only one of the genes, pilC2, was expressed . Inactivation of pilC2 by a mTnCm insertion resulted in a nonpiliated phenotype, while a mTnCm insertion in pilC1 had no effect on piliation . Expression of pilC was found to be controlled at the translational level by frameshift mutations in a run of G residues positioned in the region encoding the signal peptide . Nonpilated (P-), pilin expressing colony variants that did not express detectable levels of PilC were selected; all P+ backswitchers from these P-, PilC- clones were found to be PilC+ . The structural gene for pilin, pilE, was sequenced and found to be identical in one P-, PilC- and P+, PilC+ pair . Most PilC- cells were completely bald whereas the PilC+ backswitcher had 10-40 pili per cell . Thus, a turn ON and turn OFF in the expression of PilC results in gonococcal pili phase variation . These results suggest that PilC is required for pilus assembly and/or translocation across the gonococcal outer membrane.

Biochemistry, 1991 Jan 22, 30(3), 851 - 7
Three-dimensional structural analysis of the group B polysaccharide of Neisseria meningitidis 6275 by two-dimensional NMR: the polysaccharide is suggested to exist in helical conformations in solution; Yamasaki R et al.; The solution conformations of the group B polysaccharide of Neisseria meningitidis were analyzed by DQF-COSY and pure absorption 2D NOE NMR with three mixing times . The pyranose ring of the sialic acid residue was found to be in the 2C5 conformation . The DQF-COSY analysis indicated that the orientations of H6 and H7 and of H7 and H8 are both gauche . In order to overcome the difficulties in analyzing the NOE data due to the two sets of proton overlaps, molecular modeling of alpha-2,8-linked sialic acid oligomers was carried out to investigate possible conformers, and theoretical NOE calculations were performed by using CORMA (complete relaxation matrix analysis) . Our analysis suggests that the polysaccharide adopts helical structures for which the phi (defined by O6-C2-O8-C8) and psi (C2-O8-C8-C7) angles are in the following ranges: phi -60 to 0 degrees, psi 115-175 degrees or phi 90-120 degrees, psi 55-175 degrees . The weak affinity of anti-B antibodies for smaller alpha-2,8-linked oligosaccharides may be due to the fact that such oligomers are more flexible and may not form an ordered structure as the poly(sialic acid) does.

Ugeskr Laeger, 1991 Jan 21, 153(4), 284 - 8
{Neonatal conjunctivitis after the abolition of compulsory Credé prophylaxis}; Gadeberg OV et al.; The prescript requiring application of silver nitrate eye drops (0.66% AgNO3) to the conjunctivae of the newborn within two hours after delivery was revoked in March 1985 . The present study comprises a prospective investigation of the occurrence of microorganisms in specimens of eye secretion from neonates received during the period February-April 1986, and a review of findings of Neisseria species and B . catarrhalis in 3,485 specimens of ocular secretions and of C . trachomatis in 1,240 conjunctival scrapes received at the Neisseria Department 1986-1988 . The numbers of cases of conjunctivitis neonatalis caused by the following microorganisms were: N . gonorrhoeae 8, N . cinerea 6, other Neisseria species 8, B . catarrhalis 49 and C . trachomatis 92 . During the period 1984-1988, the total number of neonates with gonococcal conjunctivitis neonatalis was 18 . The gonococcal infection was diagnosed within the first week of life in 50% of the cases but could occur as late as in the fourth week of life . Similarly, infection with B . catarrhalis was most common in neonates less than one week old (49%), whereas chlamydial infection was most common in the second week of life (39%) . It is concluded that the eyes of neonates should be carefully observed for at least four weeks and that microbiological examinations for gonococci and chlamydia are indicated if signs of infection appear.

Sex Transm Dis, 1991 Jan-Mar, 18(1), 28 - 35
Unsuspected Chlamydia trachomatis infection in heterosexual men attending a sexually transmitted diseases clinic: evaluation of risk factors and screening methods; Rietmeijer CA et al.; To characterize the problem of unsuspected Chlamydia trachomatis infection in heterosexual men attending a sexually transmitted diseases (STD) clinic, the authors assessed risk factors for infection and the value of screening for infection by gram-stained smears and urinalysis in 438 men who did not have conventional clinical indications for chlamydial treatment at their initial visit . Evaluations included urethral swabs for gram-stained smears and Neisseria gonorrhoeae and C . trachomatis cultures and microscopy of first-catch urine sediment . C . trachomatis was isolated from 29 subjects (6.6%) and N . gonorrhoeae from 6 subjects (1.3%), (P less than .05) . The only demographic or clinical factors that were associated with C . trachomatis were age younger than 21 years and five or more lifetime sexual partners . Screening for C . trachomatis with urethral gram stain and urine sediment examination had sensitivities of only 23% and 35%, respectively . Risk factor assessment and screening with standard microscopic procedures do not adequately predict infection in this group, which accounts for almost 25% of the C . trachomatis burden in heterosexual men who visit an STD clinic . More specific chlamydia detection methods are needed for effective control programs.

Arch Gynecol Obstet, 1991, 249(2), 95 - 101
The effect of ciprofloxacin and doxycycline plus metronidazole on lower genital tract flora in patients with proven pelvic inflammatory disease; Miettinen A et al.; Alterations in the lower genital tract flora were studied during antimicrobial treatment of 36 women with acute pelvic inflammatory disease (PID) . Sixteen women received ciprofloxacin, and 20 received doxycycline plus metronidazole . Both regimes eradicated Chlamydia trachomatis in all cases and Neisseria gonorrhoeae in all except one in which combination treatment failed because of resistance of the organism to tetracycline . Both regimes eradicated Mycoplasma hominis in all cases, while ciprofloxacin was somewhat less effective than combination treatment against Ureaplasma urealyticum . Ciprofloxacin was less effective than combination treatment against Gardnerella vaginalis . The incidence of Candida infection increased equally in both groups, although symptoms necessitating antifungal treatment were rare.

NAACOGS Clin Issu Perinat Womens Health Nurs, 1991, 2(3), 313 - 21
Abnormal bleeding associated with reproductive tract infection; French JI; Reproductive tract infection is an often unrecognized, but relatively common, cause of abnormal reproductive tract bleeding . Postcoital bleeding, menorrhagia, metrorrhagia, and oral contraceptive break-through bleeding are potentially infection-related complaints . The microorganisms most often associated with abnormal reproductive tract bleeding include: Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus type 2, and microorganisms associated with bacterial vaginosis . The clinical conditions cervicitis, endometritis, and pelvic inflammatory disease and the related microorganisms are discussed, as are strategies for clinical management and counseling.

Bull Soc Pathol Exot, 1991, 84(2), 136 - 44
{Analysis of 190 strains of Neisseria gonorrhoeae isolated in Yaounde from 1984 to 1987: auxotypes, plasmidic contents, antibiotic sensitivity}; Abong BT et al.; Gonococcal infections are always a public health problem in Cameroon . From January 1984 to December 1987, 2,074 strains have been isolated in the "Centre Pasteur du Cameroun" . Among these strains, 190 had been studied in details concerning antibiotic susceptibility, auxotypes and plasmidic content . Penicillinase producing Neisseria gonorrhoeae (PPNG) were increasingly isolated: 32.28% (1984); 59.57% (1987) . Auxotypes prototrophes and proline requiring were more often isolated . Plasmidic content showed essentially african type (with or without conjugative plasmid) but also asian type.

Biol Met, 1991, 4(2), 126 - 31
Characterization of a soluble ferric reductase from Neisseria gonorrhoeae; Le Faou AE et al.; An NADH-dependent ferric reductase was identified in extracts of Neisseria gonorrhoeae . Enzyme activity was measured in an assay using ferrozine as the ferrous iron acceptor . Ferric reductase activity was enhanced by Mg2+ and flavine nucleotides . The enzyme reduced both citrate- and diphosphate-bound ferric iron as well as ferric hydroxide (Imferon) . However, no activity was observed with either 30%-iron-saturated transferrin or with the gonococcal iron-binding protein, Fbp . The ferric reductase was found primarily within the cytoplasmic cell fraction . The soluble ferric reductase was purified 110-fold by ammonium sulfate precipitation, gel and anion-exchange chromatography . Results obtained following gel chromatography and SDS/polyacrylamide gel electrophoresis suggested that the enzyme had a molecular mass of about 25 kDa.

Kansenshogaku Zasshi, 1991 Jan, 65(1), 77 - 87
{A study on the beta-lactamase production for Neisseria gonorrhoeae and the sensitivity to various antibacterial agents}; Nishimura M et al.; During the 10-year period from 1980 through 1989 using gonococci isolated in Sapporo, we studied beta-lactamase production capacity and the sensitivity of various antibacterial agents and obtained the following results . 1 . The frequency of isolating beta-lactamase producing gonococci (PPNG) displayed a gradual tendency to increase during the first half of the 80's and reached a peak in 1985 of 23.9% (61/255) . However, thereafter it tended to decline and in 1989 it was 6.3% (2/32) . 2 . The sensitivity to penicillin-type antibacterial agents was higher against PPNG than non-PPNG against PCG, ABPC, and AMPC displaying about a 7 level MIC90 so that it was quite sensitive . Against CVA/AMPC, SBTPC it showed a relatively favorable MIC90 . Also, the sensitivity of PPNG against AMPC with 1984 as the boundary, thereafter the MIC distribution was observed to decline somewhat . 3 . Against the monobactam-type injectable drug, AZT, both non-PPNG and PPNG showed a low MIC distribution and against SPCM both showed a relatively high MIC distribution of 3.13-25 micrograms/ml . 4 . In regard to the sensitivity to cephem-type antibacterial agents, against such 3rd generation injectables as CZX, CFTM-PI, etc . it displayed a particularly low MIC distribution . 5 . Against tetracycline and macrolide antibacterial agents, it displayed a relatively high MIC distribution . 6 . Against new quinolone type antibacterial agents, regardless of being non-PPNG or PPNG, it showed a low MIC.

Sex Transm Dis, 1991 Jan-Mar, 18(1), 5 - 9
Gonorrhea in women prostitutes: clinical data and auxotypes, serovars, plasmid contents of PPNG, and susceptibility profiles; Vazquez F et al.; Eighty-nine women prostitutes who underwent clinical and microbiologic examination were found to have gonococcal infection . The median age was 22; 92.1% were from urban areas . Nearly all the women prostitutes refrained from barrier methods (92.1%) and had contact with several partners (91.0%) . The most frequent clinical findings were leukorrhea (50.6%), cervicitis (20.2%), and pelvic inflammatory disease (PID) (18.0%) . Eighty-one women prostitutes (93.1%) had experienced a previous STD, with Chlamydia trachomatis (34.8%), Trichomonas vaginalis (30.3%), Neisseria gonorrhoeae (29.2%), and Ureaplasma urealyticum (23.6%) as the most frequent microorganisms isolated . Microorganisms associated with N . gonorrhoeae were isolated, mainly T . vaginalis (40.4%), C . trachomatis (31.5%), and Mycoplasma hominis (21.3%) . For N . gonorrhoeae, the most frequent auxotypes were prototrophic (67.4%) and Proline (Pro)-dependent (14.6%); 2.2% of the strains were non-auxotypable . Beta-lactamase production was detected in three strains (3.4%) belonging to the auxotype/serovar: Lys/IA, Prototrophic/IB, and Pro/IB . The two former produced the 3.2-MDa "African" plasmid; the latter produced two plasmids (the 4.5-MDa "Asian" and the 24.5-MDa transfer plasmid.

Sex Transm Dis, 1991 Jan-Mar, 18(1), 18 - 20
Evaluation of ofloxacin in the treatment of uncomplicated gonorrhea; Smith BL et al.; In an open study, a single oral dose of 400 mg of ofloxacin was administered to 40 men and 20 women who required treatment for uncomplicated gonococcal infection . Thirty-six men and 13 women were evaluable . Ofloxacin eradicated 49 of 49 urethral or endocervical gonococcal infections and 1 of 1 pharyngeal infection . There were 55 pretreatment isolates of Neisseria gonorrhoeae available for antimicrobial susceptibility testing . Twenty-four (43.6%) produced penicillinase . Eighteen (32.7%) isolates that did not produce penicillinase had penicillin MICs greater than or equal to 1.0 micrograms/mL . Twelve (21.8%) isolates had tetracycline MICs greater than or equal to 16 micrograms/mL . The geometric mean minimal inhibitory concentrations (range) for 55 pretreatment N . gonorrhoeae isolates were: ofloxacin, 0.014 (.0078-.03) micrograms/mL; penicillin, 6.30 (.125-128) micrograms/mL; and tetracycline 1.61 (.03-128) micrograms/mL . There were few side effects . Ofloxacin appears to be an effective and safe oral therapy for the treatment of infections caused by N . gonorrhoeae including infections due to penicillin- and tetracycline-resistant strains.

Vaccine, 1991 Jan, 9(1), 60 - 6
Immunogenicity in adult males of a Neisseria meningitidis group B vaccine composed of polysaccharide complexed with outer membrane proteins; Lifely MR et al.; Twenty five adult male volunteers were given a vaccine composed of the capsular B polysaccharide non-covalently complexed to serotype 6 outer membrane proteins (OMP) of Neisseria meningitidis . Subjects were divided into three dose groups receiving 50, 100 or 150 micrograms vaccine in aluminium hydroxide in each of three injections spaced 4 weeks apart . Systemic signs/symptoms considered clinically significant were recorded on 6% (4/70) of occasions and were succeeded by withdrawal of two volunteers from the study . Local injection site reactions, mostly mild to moderate, were reported after all vaccinations with one such reaction leading to a third volunteer withdrawing from the study . Geometric mean anti-B responses before immunization and 1 week after the third immunization (9 weeks) were 3.60 and 7.12 micrograms ml-1 in the 50 micrograms group (p less than 0.05) 2.05 and 12.19 micrograms ml-1 in the 100 micrograms group (p less than 0.001), and 3.68 and 14.20 micrograms ml-1 in the 150 micrograms group (p less than 0.001) . The anti-B response was predominantly of the IgM isotype and persistence above prevaccination levels was evident for at least 12 months . Anti-type 6 OMP responses were also evidenced with geometric mean multiplicative increases over prevaccination levels at 9 weeks and 6 months of 7.8 and 4.2 for the 50 micrograms group, 11.6 and 5.6 for the 100 micrograms group and 6.8 and 3.4 for the 150 micrograms group . The bulk of this response was of the IgG isotype . Passive protection of mice was achieved with both pre- and post-vaccination (9 weeks; 100 and 150 micrograms groups) pools of sera.(ABSTRACT TRUNCATED AT 250 WORDS)

Ethiop Med J, 1991 Jan, 29(1), 27 - 35
Community-wide outbreak of Neisseria gonorrhoeae conjunctivitis in Konso district, North Omo administrative region; Mikru FS et al.; We describe a large outbreak of severe pustular conjunctivitis due to Neiserria gonorrhoeae . Over 9,000 cases occurred during 8 months in 1987-1988 in one district in North Omo, Ethiopia . Both sexes and all age groups were affected, particularly children under 5 years of age; only a small minority were neonates . Despite a highly successful cure rate for individual cases, the outbreak continued for a number of months . Several epidemiologic approaches were used to monitor the outbreak and identify the mechanism of transmission . The epidemic curve suggested person-to-person transmission . Routine surveillance data showed that there was no concurrent genital gonorrhea outbreak and genital transmission could not explain a community-wide outbreak . In the setting of intense crowding and relative lack of water, peak transmission of illness coincided with two periods following the rains, suggesting that flies were important in transmission . A case-control study identified lack of face-washing as a household risk factor . Eighty seven of one-hundred and forty six (59%) control houses with children were judged to contain children with clean faces, while only 102 of 216 (47%) case households contained children with clean faces (p less than .05) . Our recommendations include measures to improve personal hygiene.

J Med Microbiol, 1991 Jan, 34(1), 23 - 7
4-Quinolone-resistant Neisseria gonorrhoeae in the United Kingdom; Gransden WR et al.; The auxotype, serogroup and antimicrobial susceptibility of 977 clinical isolates of Neisseria gonorrhoeae obtained at St Thomas' Hospital, London, during 1989 were determined; 23 isolates from 15 patients were resistant to 4-quinolones . Twelve of the patients acquired their infection in the UK and these strains were generally sensitive to other antimicrobial agents; strains from 10 patients were of serogroup IB-6 . Three patients acquired their strains outside the UK and these isolates were multi-resistant and of different serogroups.

Am J Emerg Med, 1991 Jan, 9(1), 77 - 80
Retropharyngeal space infections in a community hospital; Gradon JD et al.; The emergency physician often has to deal with infectious disease emergencies . The authors have seen four cases of retropharyngeal infection of potentially life-threatening severity in less than 1 year, all were admitted through the emergency department (ED) . Reporting these cases is important to increase awareness among emergency physicians of this classic disease entity . The characteristics of the patients are discussed including initial diagnostic approaches and the use of computed tomography (CT) scanning of the neck and mediastinum . One case of retropharyngeal space infection caused by Neisseria meningitidis serotype W-135 is described . This is the first such reported case . The recommendations are that, in the absence of overt focal infection, a non-surgical approach to the treatment of these patients is indicated . This should include suitable neck roentgenograms, CT scanning, and high-dose, intravenous, beta-lactamase-resistant antibiotics.

World Health Forum, 1991, 12(1), 63 - 6
A partnership in epidemiological research; Fox E et al.; Four medical research teams completed ten epidemiological investigations in Djibouti and thus provided the country's Ministry of Health with valuable information on infectious disease risks . A major factor contributing to the success of the work was the high degree of cooperation between the Ministry, a United States naval medical research unit, and the World Health Organization as coordinatorPIP: Epidemiologic research has the potential to complement public health technical assistance programs and to provide health planners with information on priority areas for intervention . This potential was documented in Djibouti, where a US naval medical research unit conducted 10 epidemiologic investigations preliminary to the planning of a national acquired immunodeficiency syndrome (AIDS) control program . Data were collected on human immunodeficiency virus (HIV) prevalence and incidence in high-risk populations, the comparative performance of HIV screening assays, attitudes and practices relevant to sexually transmitted diseases, viral hepatitis markers, the prevalence of arboviral infections, the nature and drug susceptibility of microbial pathogens associated with infectious diarrhea and Neisseria gonorrhoea, the epidemiology of malaria, and the ecology of sandflies in relation to human leishmaniasis . These findings were utilized in the setting of priorities and the planning of disease control measures . Baseline epidemiologic data are now available, and national research capabilities have been strengthened so that further research on AIDS , malaria, and diseases such as leishmaniasis can be conducted . The success of this experience was in large part due to the cooperation and coordination between the research unit, the Ministry of Health, and a World Health Organization Collaborating Center on AIDS .

Mol Microbiol, 1991 Jan, 5(1), 137 - 48
Control of pilus expression in Neisseria gonorrhoeae as an original system in the family of two-component regulators; Taha MK et al.; We have previously reported the identification of two genes, pilA and pilB, which act in trans to regulate pilus expression in Neisseria gonorrhoeae . Here we show that PilA and PilB have amino acid sequence similarities with members of the two component 'sensor-regulator' family of proteins . PilB has homology with histidine kinase sensors . Alkaline phosphatase fusions to the predicted sensor and transmitter domains are described . Their PhoA activity and cellular location suggest that PilB is inserted in the cytoplasmic membrane and predict periplasmic and cytoplasmic locations for the sensor and the transmitter domains, respectively . PilA has homology with response regulators in its N-terminal part, and with components of the eukaryotic protein secretory apparatus (SRP 54 and SRP receptor) as well as two Escherichia coli gene products in its C-terminal part . In particular, it contains a putative GTP-binding site . Mini-transposon insertions into different regions of pilA were obtained . The phenotypes and genotypes of these mutants and preliminary biochemical studies of the gene products of two of these mutants lend further support to the hypothesis that PilA is a DNA-binding response regulator and confirm that it participates in an essential function in the bacterium.

Arch Inst Pasteur Tunis, 1991 Jan-Apr, 68(1-2), 27 - 31
{Sensitivity of Neisseria gonorrhoeae to antibiotics}; Kechrid A; Since 1976 strains of Neisseria gonorrhoeae producing beta-lactamase have been isolated in many countries . Strains with high level resistance to tetracycline have been also described . The appearance of resistant strains implies a constant surveillance of the isolated gonococcus and the study of their antibiotics sensitivity.

Zentralbl Gynakol, 1991, 113(11), 613 - 23
{Salpingitis}; Hoyme UB; The etiology of salpingitis is polymicrobial, however, the particular pathogen is difficult to identify, even in laparoscopically obtained specimens . Chlamydia trachomatis, Neisseria gonorrhoeae, anaerobes and facultative anaerobic bacteria have to be covered by antimicrobial therapy . This article reviews the current aspects of etiology, diagnosis, therapy, prevention and complications of salpingitis.

Przegl Epidemiol, 1991, 45(3), 183 - 9
{Meningitis and encephalitis in the years 1983-1990 . Clinical observations}; Kepa L et al.; From 1983 to 1990, at the I Clinic of Infectious Diseases, Silesian Academy of Medicine in Bytom, 995 patients with meningitis and encephalitis were treated; the average age was 17.86 years . After cerebrospinal fluid (CSF) examinations the patients were divided into groups . The first group consisted of patients with suppurative meningitis and encephalitis (202-20.30%), the other group were patients with aseptic meningitis (309-31.06%), a separate group consisted of patients with mumps meningitis (484-48.06% cases) . In the group with suppurative meningitis and encephalitis etiological agents were isolated (Gram stain smear and/or culture of CSF) in 50.99% of cases . The most common causes of suppurative neuroinfections were: Neisseria meningitides and Streptococcus pneumoniae (in 23.76% cases) . The increasing number of bacteriological tests positive results was observed during the analyzed period . The etiology of aseptic inflammation diseases of the central nervous system was defined with the help of serologic blood tests in 10-15%, and serologic confirmation of mumps meningitis was as high as 80% of cases . In the group of purulent neuroinfections, during the 8-year observation, 36 deaths occurred (17.82% of these patients) . The observed tendency of the death rate decrease is concerned to be a result of better microbiological diagnostics and the possibility of an early aimed antibiotic therapy.

Reprod Fertil Dev, 1991, 3(6), 743 - 6
Screening for Neisseria gonorrhoeae and Chlamydia trachomatis in a donor insemination programme; Haddad Y et al.; Cultures of all 4450 specimens of semen from 193 semen donors were negative for N . gonorrhoeae . A MicroTrak direct fluorescence microscopy test for the detection of Ch . trachomatis was used to screen 448 specimens from all 268 recipients of semen on an insemination programme for 3 1/2 years; all pre-insemination endocervical samples and all subsequent endocervical samples were negative . It is considered that the incidence of gonorrhoeae or chlamydia in our recipients or donors is very low . Fluorescence microscopy is a specific and cost-effective screening technique for Ch . trachomatis.

J Clin Microbiol, 1991 Jan, 29(1), 70 - 5
Binding of S protein by Neisseria gonorrhoeae and potential role in invasion; Arko RJ et al.; An agglutination assay was used to examine the binding of purified human S protein (vitronectin, serum spreading factor) to 201 clinical isolates of Neisseria gonorrhoeae . Strains belonging to the protein IA serovars were significantly (P less than 0.001) more reactive in agglutination tests with human S protein and were more serum resistant than strains belonging to the protein IB serovars . The strains from patients with disseminated infections belonged predominantly to the IA serovar (19 of 23) and, with the exception of IA-4 and certain IB serovars, avidly agglutinated with S protein . The serovar IA-4 and IB strains isolated from joint or cerebrospinal fluid failed to agglutinate with S protein and appeared to be less serum resistant than most other IA isolates . Cysteine hydrochloride or 2-mercaptoethanol inhibited agglutination of S protein and a more than twofold increase in resistance to killing by fresh human serum following preincubation with S protein; the serum-sensitive parent strain did not agglutinate S protein, and serum resistance was not increased following preincubation with this protein . Binding of S protein by gonococci may represent a novel pathogenic mechanism that can contribute to serum resistance.

AIDS, 1991, 5 Suppl 1, S183 - 91
Condom issues in AIDS prevention in Africa; Lamptey P et al.; PIP: In vitro studies have demonstrated that an intact latex condom provides an effective barrier against several sexually transmitted pathogens, including herpes simplex virus type 2, hepatitis B virus, cytomegalovirus, HIV, Neisseria gonorrhea, Chlamydia trachomatis, and mycoplasma . This paper discusses some of the major advances and critical issues which should be incorporated in condom program design and implementation . The authors drew extensively from their experience with Family Health International's AIDSTECH Project with 21 targeted HIV prevention programs in 14 African countries . The programs are designed primarily to reach high-risk behavior groups among whom the virus is most prevalent . The authors observe from their work that a number of social, economic, political, and cultural obstacles impede greater condom use in Africa; private sector initiatives which recruit members of target populations to be key personnel in project implementation show promise for reaching high-risk behavior groups; condom logistics systems remain a weak link in condom distribution programs; rising costs and inadequate sources of latex condoms are problematic; and alternatives to the male latex condom could be commercially available by 1992 . Sections discuss barriers to condom use, new approaches in condom distribution, condom quality assurance, condom costs and economics, and technological advances in condoms .

Pharm Weekbl Sci, 1990 Dec 14, 12(6A), 268 - 74
Gynaecological infections and strategies for treatment; Roex AJ; Frequently, encountered gynaecologic infections and pathogens involved are presented . A review is given of bartholinitis, vulvovaginitis-bacterial vaginosis, candidiasis, trichomoniasis cervicitis and pelvic inflammatory disease: Neisseria gonorrhoeae, Chlamydia trachomatis and herpes simplex virus 2 . Of each infection a thorough description of clinical symptoms and diagnostic criteria is followed by up-to-date treatment advices . For vulvovaginitis, cervicitis and pelvic inflammatory disease antifungal and antimicrobial agents, route of administration, the required daily dosage and time of administration are presented in an overview table.

J Immunol Methods, 1990 Dec 5, 134(2), 215 - 25
Comparison of methods for the analysis of outer membrane antigens of Neisseria meningitidis by western blotting; Davies RL et al.; The method of extraction of outer membrane proteins (OMPs), the conditions of electrophoretic transfer, and the conditions of antibody binding, were compared in Western blotting studies of Neisseria meningitidis outer membrane antigens . The OMP profiles obtained by SDS-PAGE of outer membrane vesicles extracted with lithium chloride/sodium acetate were compared with profiles obtained by Sarkosyl extraction; these profiles were further compared with the patterns obtained by 125I-labelling of surface-exposed proteins . Sarkosyl extracts gave profiles most closely resembling those of 125I-labelled whole-cells and gave the best resolution of the major proteins . After transfer in Tris-glycine-methanol buffer some proteins, including the major proteins, were not completely transferred and remained in the gel, with the class 2/3 and 5 proteins not effectively detected on nitrocellulose by amido black staining . There was weak antibody recognition of the class 1 and 4 proteins but good recognition of lipooligosaccharide (LOS) and H8 antigen . Empigen BB had no effect on renaturation of the class 1 protein . When 0.1% SDS was incorporated in the same buffer all of the proteins were removed from the gel, and although the major proteins bound to nitrocellulose other proteins did not . There was weak antibody recognition of the class 1 and 4 proteins, stronger reaction to the class 5 protein, but no recognition of the class 2 protein, LOS or H8 antigen, Empigen BB slightly enhanced antibody recognition of the class 1 protein . After transfer in Tris-glycine buffer, all the major proteins were transferred and bound to nitrocellulose and, other than the class 2 protein, were recognised by antibody, both in the presence or absence of Empigen BB, as were LOS and the H8 antigen . Differences existed in the patterns of antibody recognition between the lithium and the Sarkosyl extracts; additional proteins were recognised in the lithium extracts . The surface-labelling studies indicated, however, that some of these proteins were not surface-exposed . Some minor proteins appeared to be more highly immunogenic than the major proteins.

Semin Arthritis Rheum, 1990 Dec, 20(3), 174 - 84
Increased risk of neisserial infections in systemic lupus erythematosus; Mitchell SR et al.; Survival in systemic lupus erythamatosus (SLE) continues to improve because of better ancillary care, earlier diagnosis, and earlier treatment . However, infection remains a leading cause of morbidity and mortality in this disease . Although corticosteroids and immunosuppresives increase the risk of opportunistic infection, the SLE patient is still most at risk from common bacterial pathogens . As the prototypic immune-complex disease, patients with active SLE have low circulating complement as well as a reticuloendothelial system (RES) saturated with immune complexes . It seems intuitive that SLE patients should be most at risk for organisms dependent for their removal on the RES or complement for opsonization or bacteriolysis . The current series presents four patients with SLE and disseminated neisseria infection and brings to 14 the number of patients in the literature with disseminated neisserial infection . They are typically young, female, with renal disease, and either congenital or acquired hypocomplementemia, and may present with all features of a lupus flare . Surprisingly, they are not all on corticosteroids or immunosuppressives and have some features that are unusual for non-SLE patients with these infections . There seems to be an over-representation of Nisseria meningitidis (despite potential reporting bias), and there ironically may be better tolerance with fewer fulminant complications in patients who have complement deficiencies . The best approach for the physician treating SLE is to immunize all SLE patients with available bacterial vaccines to N meningitidis and Streptococcus pneumonia, have a low threshold of suspicion for the diagnosis of disseminated neisserial or other encapsulated bacterial infection in the SLE patient who is sick, and to treat empirically with third generation cephalosporins after appropriate cultures.

Infect Dis Clin North Am, 1990 Dec, 4(4), 645 - 59
Bacterial meningitis in adults; Wispelwey B et al.; Bacterial meningitis continues to be an important cause of morbidity and mortality despite the availability of effective bactericidal antibiotics . Penicillin or ampicillin remains the drug of choice for meningitis caused by Streptococcus pneumoniae and Neisseria meningitidis . The third generation cephalosporins have revolutionized the treatment of gram-negative meningitis . Future therapy for bacterial meningitis will use recent developments in the understanding of pathogenic and pathophysiologic mechanisms underlying this disease.

Genitourin Med, 1990 Dec, 66(6), 433 - 8
Sexually transmitted diseases in rape victims; Estreich S et al.; From 1 January 1986 to 1 September 1989 124 women presented to the Ambrose King Centre (the department of genitourinary medicine of the London Hospital) alleging rape . Sexually transmitted diseases were found in 36 (29%) women (excluding candidosis and bacterial vaginosis) . The commonest organisms detected were Neisseria gonorrhoeae and Trichomonas vaginalis, each being present in 15 patients . Eleven women had genital warts . Chlamydia trachomatis was isolated in six patients, two had herpes simplex virus infection and one patient had pediculosis pubis . Serological evidence of past hepatitis B infection was detected in five women and one patient had antibodies to human immunodeficiency virus . Eighteen of the 36 women (50%) had multiple infections . Six women had abnormal cervical cytology smears, three being suggestive of cervical intraepithelial neoplasia grades II-III . Although it is rarely possible to attribute infection to an assailant, these patients require further counselling, treatment and review . Rape victims are thus a population at risk of having sexually transmitted diseases and screening should be offered.

Epidemiol Infect, 1990 Dec, 105(3), 559 - 63
Neisseria cuniculi in ruminants: epidemiological aspects; Elad D et al.; Neisseria cuniculi was isolated, between March 1987 and March 1989, from 38 cases of respiratory disease in small and large ruminants . In all but five cases N . cuniculi was cultured together with other potential respiratory pathogens . A survey was conducted to assess the prevalence of N . cuniculi in the pharyngeal region of Merino and Awassi purebred sheep, Awassi/East-Friesian and Merino/Romanov crossbred sheep and one exotic cross breed (goat/ibex) . N . cuniculi was isolated from 80-88% of the animals under 1 month of age . Among older animals, the microorganism was isolated from 20.5% of the pure bred animals and 79.3% of the crossbred ones . This difference was significant (P less than 0.001) by the chi 2 test . The prevalence of N . cuniculi in the second age group coincides with the susceptibility of the breeds to respiratory pathology . This, we believe, is the first report of N . cuniculi involved in multiple cases of respiratory pathology and of a survey assessing the prevalence of this microorganism in small ruminants.

J Neurochem, 1990 Dec, 55(6), 2063 - 71
Embryonic neural cell adhesion molecule in cerebrospinal fluid of younger children: age-dependent decrease during the first year; Weisgerber C et al.; Poly-alpha-2,8-N-acetylneuraminic acid (poly-alpha-2,8-NeuAc) is developmentally expressed in neural tissue of higher animals, where it is covalently attached to the neural cell adhesion molecule (NCAM), a large integral membrane glycoprotein mediating cell-cell adhesion during neuronal development . NCAM exists in several molecular forms, of which only embryonic NCAM carries lengthy chains (n greater than 5) of poly-alpha-2,8-NeuAc . Chemically identical poly-alpha-2,8-NeuAc of bacterial origin is an important virulence factor in infections caused by Neisseria meningitidis group B and Escherichia coli K1, the predominant pathogens of bacterial meningitis . A quantitative enzyme-linked immunoassay was developed using monoclonal antibody (MAb) 735, an MAb specifically recognizing poly-alpha-2,8-NeuAc, and applied to CSF specimens from younger children . Poly-alpha-2,8-NeuAc contents were within the range of 20-0.2 micrograms/ml, decreasing from day 1 to day 300 . Immunoprecipitation, immunoblot with a rabbit anti-mouse NCAM serum recognizing the protein part of human NCAM by cross-reactivity, affinity enrichment using immobilized MAb 735, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed that poly-alpha-2,8-NeuAc in CSF is bound to human NCAM, probably NCAM-120.

Zentralbl Bakteriol, 1990 Dec, 274(3), 316 - 24
Complement genetics and host defence; Lachmann PJ; There is a surprisingly high frequency of allelic variation in complement proteins . The best candidate for a true selective polymorphism is that of C3 . For C4 and factor B within the MHC it is more difficult to identify the effects of individual alleles . No evidence suggests other alleles of C4 (and C2) than the null alleles (or the two isoproteins C4A and C4B) to have any functional differences with resistance . Thus, the major functions of complement, as shown by the effects of deficiency, are to resist infection against bacteria and particularly against Neisseria, and to prevent immune complex disease . There are also undoubtedly balancing contributions to the pathogenesis of some infections and to all immune complex disease . Data from studies of C4 polymorphism and from the presence of control proteins on micro-organisms suggest there may be in addition more subtle contributions to immunity against a variety of other infections.

Bioorg Khim, 1990 Dec, 16(12), 1693 - 5
{Synthesis of phosphodiesters of 2-acetamido-2-deoxy-D-glucose--fragments of polymers of capsules from Escherichia coli K51 and Neisseria meningitidis X}; Nikolaev AV et al.; Hydrogenphosphonate method was used for synthesis of 4-nitrophenyl 2-acetamido-3- and 4-nitrophenyl 2-acetamido-4-(2-acetamido-2-deoxy-alpha-D-glucopyranosyl phosphate)-2-deoxy-beta-D-glucopyranosides . The glycosides, phosphate diester fragments of the title bacteria capsular antigens, were obtained by H-phosphorylation of the suitably protected 2-acetamido-2-deoxy-beta-D-glucopyranosides with 2-acetamido-3,4,6-tri-O-benzoyl-2-deoxy-alpha-D-glucopyranosyl H-phosphonate in the presence of trimethylacetyl chloride followed by oxidation and deprotection.

Kidney Int, 1990 Dec, 38(6), 1089 - 94
Induction of IL-1 during hemodialysis: transmembrane passage of intact endotoxins (LPS); Laude-Sharp M et al.; Circulating monocytes of patients undergoing chronic hemodialysis are triggered to produce interleukin-1 (IL-1) in vivo . Intradialytic induction of IL-1 is associated with complement activation in patients dialyzed with first-use cellulose membranes . Chronic stimulation of IL-1 production occurs because of an yet unidentified mechanism in patients dialyzed with high permeability membranes . The present study demonstrates that intact bacterial lipopolysaccharide (LPS) molecules may cross cuprophan, AN69 and polysulfone membranes under in vitro conditions simulating in vivo hemodialysis . The experiments used purified LPS from Neisseria meningitidis and LPS from Pseudomonas testosteroni, a bacterial strain grown out from a clinically used dialysate . LPS were purified to homogeneity and radiolabeled . Transmembrane passage of 3H-labeled LPS was observed within the first five minutes of dialysis . A total of 0.1 to 1% of 3H-labeled LPS were recovered in the dialysate compartment after one hour of dialysis . High amounts of LPS, representing 40 to 70% of the amount originally present in the dialysate, were absorbed onto high permeability membranes . Low amounts of LPS were absorbed onto cuprophan membranes . The amount of LPS absorbed decreased with the concentration of LPS in the dialysate . LPS recovered from the blood compartment exhibited the same molecular weight as that used to contaminate the dialysate . Biochemically detectable transmembrane passage of LPS was not associated with that of material detectable using the limulus amebocyte lysate (LAL) assay . An IL-1-inducing activity was, however, detected in the blood compartment upon dialysis with high permeability membranes, as previously found by others with cuprophan membranes.(ABSTRACT TRUNCATED AT 250 WORDS)

Genitourin Med, 1990 Dec, 66(6), 453 - 9
Laboratory methods in genitourinary medicine . Methods of diagnosing gonorrhoea; Ison CA; Gonorrhoea is normally diagnosed presumptively by the presence of intracellular Gram-negative cocci on a Gram stain and confirmed by culture of the causative organism, Neisseria gonorrhoeae . Alternative methods have been evaluated extensively for the detection of gonococci in clinical specimens including immunological techniques such as ELISA and immunofluorescence, DNA probes, genetic transformation and the limulus lysate assay . Some of these tests have proved as sensitive and specific for the detection of gonorrhoea in symptomatic men as the Gram stain but offer no advantage in time or cost . In women, no test has been found that shows a sensitivity and specificity sufficiently adequate for clinical use . Culture in men and women remains the method of choice for diagnosis . In addition the need to obtain the infecting organism for antibiotic susceptibility testing has not been overcome . In contrast, the rapid identification of N gonorrhoeae can be achieved within four hours using either monoclonal antibodies or by the detection of preformed enzymes . New methods for both the detection and identification of N gonorrhoeae should be carefully evaluated particularly for use in cases of child and sexual abuse where medico-legal problems may arise.

Oral Surg Oral Med Oral Pathol, 1990 Dec, 70(6), 720 - 3
Effect of granulocytopenia on oral microbial relationships in patients with acute leukemia; Peterson DE et al.; Risk for acute infection increases as granulocyte levels decrease secondary to myelosuppressive chemotherapy in patients with acute nonlymphocytic leukemia (ANLL) . Acute exacerbations of concomitant inflammatory periodontal diseases can result in systemic infections in these patients . However, host-oral bacterial relationships in the periodontium in patients with ANLL are not well understood . Twenty-one adult patients with ANLL with periodontal disease ranging from gingivitis to severe periodontitis were studied . Supragingival and subgingival plaque specimens were collected before chemotherapy (prechemotherapy), and at a defined midpoint of myelosuppression (midchemotherapy; day 14) . All specimens were extensively cultured both aerobically and anaerobically . Data were submitted to a partial correlational analysis, controlling for covariation relation to oral hygiene intervention and antibiotic administration . Levels of total yeast exhibited a significant association with Staphylococcus sp . at supragingival sites midchemotherapy (r = 0.68, p less than or equal to 0.05) . Levels of total yeast also correlated positively with Pseudomonas aeruginosa at subgingival sites both prechemotherapy (r = 0.70, p less than or equal to 0.01) and midchemotherapy (r = 0.61, p less than or equal to 0.05) . Significant correlations of levels of Veillonella sp . with Neisseria sp . and gram-negative enteric bacilli were observed in both supragingival (r = 0.95, 0.77, p values less than or equal to 0.01) and subgingival (r = 0.69, 0.61, p values less than or equal to 0.05) plaque specimens midchemotherapy but not prechemotherapy . These data suggest that potentially pathogenic bacteria occur in plaque simultaneous with granulocytopenia in these patients . Multiple mechanisms, including intergeneric coaggregation and other symbiotic relationships, may influence infectivity of the mixed plaque flora and thus contribute to the oral ecology observed in these patients.

J Bacteriol, 1990 Dec, 172(12), 7293 - 6
recA and catalase in H2O2-mediated toxicity in Neisseria gonorrhoeae; Hassett DJ et al.; Neisseria gonorrhoeae cells defective in the biosynthesis of the recA gene product are no more sensitive to hydrogen peroxide than wild-type cells . Although gonococci possess nearly 100-fold-greater catalase levels than Escherichia coli, they are more susceptible to hydrogen peroxide than this organism . The natural niche of gonococci undoubtedly results in exposure to oxidant stress; however, they do not demonstrate particularly efficient antioxidant defense systems.

Antimicrob Agents Chemother, 1990 Dec, 34(12), 2445 - 8
Antimicrobial interference with bacterial mechanisms of pathogenicity: effect of sub-MIC azithromycin on gonococcal piliation and attachment to human epithelial cells; Gorby GL et al.; The effects of subinhibitory concentrations of azithromycin (CP-62,993) on the piliation and attachment properties of Neisseria gonorrhoeae were examined . Subinhibitory concentrations of azithromycin significantly reduced the percentage of gonococci that expressed assembled pili on their surfaces by decreasing pilin subunit synthesis and substantially decreased gonococcal adherence to human mucosal cells.

Infect Immun, 1990 Dec, 58(12), 4145 - 8
Conservation of Neisseria gonorrhoeae pilus expression regulatory genes pilA and pilB in the genus Neisseria; Taha MK et al.; The pili of Neisseria gonorrhoeae mediate bacterial adhesion to the host-susceptible tissues . We have previously reported the identification of two genes, pilA and pilB, which act in trans to regulate pilus expression . Besides this regulatory function, pilA participates in an essential function for bacterial viability . Here we show that pilA and pilB homologs are also present in a variety of other members of the Neisseriaceae family of bacteria in contrast to the gonococcal pilin gene which hybridizes only to the pathogenic Neisseria species.

J Antibiot (Tokyo), 1990 Nov, 43(11), 1359 - 66
Antibiotic SB22484: a novel complex of the aurodox group . II . Structure elucidation of the four factors; Ferrari P et al.; SB22484, active against Neisseriae gonorrhoeae and Neisseriae meningitidis, is a complex of four factors, designed 1 through 4, which from two pairs of isomers, 1 and 3, and 2 and 4 . Factors 1 and 3 account for 65% of the complex, factor 3 being the predominant one . On the basis of the existing and implemented correlations between structure and physico-chemical characteristics (UV and IR spectroscopies, ionization properties, MS as FAB and as negative and positive CI, 1H NMR spectroscopy as 2D COSY and NOESY) in the aurodox field, the complete structures were assigned . Factor 3 can be described as N-{7-{5(R)-{7-{1,2-dihydro-4-hydroxy-1H-2-oxo-3-pyridinyl}-6-methyl- 7-oxo-1(E),3(E),5(E)-heptatrienyl}tetrahydro-3(S),4(R)-dihydrox yfuran-2 (S)-yl}-6(S)-methoxy-5,7(R)-dimethyl-2(E),4(E)-heptadienyl}-alpha (S)-methyl-5(S)-methyltetrahydro-2(S),4(S or R)-dihydroxy-6(S)-{1(E), 3(Z)-pentadienyl}-2H-pyran-2-acetamide . Factor 1 is an epimer of factor 3 with the opposite configuration at the anomeric center . Factors 2 and 4 have an ethyl group instead of the methyl group alpha to the acetamide moiety and are in the same stereochemical relationship as the pair 1 and 3.

J Infect Dis, 1990 Nov, 162(5), 1199 - 201
Neisseria mucosa endocarditis; Bacon AE 3rd et al.; A case of Neisseria mucosa tricuspid valve endocarditis in an intravenous drug abuser is described . The patient was treated initially with intravenous penicillin G followed by oral penicillin VK but relapsed . He was cured after 4 weeks of combined therapy with penicillin G and gentamicin . In vitro synergy studies performed on the patient's and two other isolates revealed synergy in all three . Thus, combination therapy is recommended for treatment of recalcitrant cases of bacterial endocarditis caused by N . mucosa.

Microb Pathog, 1990 Nov, 9(5), 369 - 73
Neisseria gonorrhoeae colonises the genital tract of oestradiol-treated germ-free female mice; Taylor-Robinson D et al.; Germ-free BALB/c mice treated with oestradiol and inoculated intravaginally with a serum-resistant strain or a freshly isolated, piliated strain of Neisseria gonorrhoeae were colonised vaginally . The organisms were recovered intermittently for a month or longer and there was evidence that they could reach the upper genital tract . Mice given progesterone and those not treated with either hormone did not become colonised . This is the first evidence of sustained mucosal colonisation in animals other than chimpanzees.

Zh Mikrobiol Epidemiol Immunobiol, 1990 Nov, (11), 50 - 6
{The sorption of a protein-polysaccharide complex isolated from Neisseria meningitidis serogroup B on aluminum hydroxide gels and the immunological activity of the sorbed preparations}; Bugaev LV et al.; The protein-polysaccharide complex, isolated from group B N . meningitidis, is a variant of vaccine for the prophylaxis of group B N . meningitidis infection . In this investigation the influence of the complex of the physical properties of aluminium hydroxide gels, the amount of gel, pH and the duration of sorption on the process of sorption has been studied . Aluminium hydroxide has been shown to produce a stimulating effect on the response of mice to the polysaccharide and protein contained in the complex after immunization made in two injections . Gels with a smaller particle size have been found to possess greater adjuvant activity, as well as greater absorbing activity . The immunological activity of the complex, adsorbed ex tempore, has proved to be no different from that of the complex adsorbed in an hour.

Indian J Med Res, 1990 Nov, 91, 443 - 7
Microbiological study of urethritis in men attending a STD clinic; Pillai A et al.; A microbiological study of 275 male patients suffering from urethritis and 100 healthy male controls showed that Neisseria gonorrhoeae (130), Ureaplasma urealyticum (81), Staphylococcus aureus (38), and alpha and beta streptococci (34) were the common isolates . Specificity and sensitivity of the direct fluorescent antibody technique in the detection of N . gonorrhoeae in 130 urethral samples, were found to be 100 per cent . Penicillin (10 units/disc) resistance was found in 36.93 per cent of N . gonorrhoeae . Minimum inhibitory concentration of penicillin for 75 isolates of N . gonorrhoeae (including 5 beta lactamase producers) varied from 0.01-5 micrograms/ml with a 95 per cent confidence limit range of 0.26-0.61 microgram/ml . Most of the N . gonorrhoeae isolates tested were sensitive to norfloxacin and spectinomycin . Inclusion bodies of Chlamydia trachomatis were observed in 25 patients.

Antimicrob Agents Chemother, 1990 Nov, 34(11), 2277 - 9
Cloning and characterization of a DNA fragment that confers sulfonamide resistance in a serogroup B, serotype 15 strain of Neisseria meningitidis; Kristiansen BE et al.; By cloning studies and complementation experiments, the sulfonamide resistance gene of a serogroup B and serotype 15 (B:15) strain of Neisseria meningitidis was localized to a 1.2-kb chromosomal SspI fragment expressing a drug-resistant dihydropteroate synthase . The fragment hybridized to DNA from both resistant and susceptible strains, suggesting that the resistance gene is a variant of the normal gene for dihydropteroate synthase.

Kansenshogaku Zasshi, 1990 Nov, 64(11), 1385 - 93
{Study on auxotype and serotype of Neisseria gonorrhoeae}; Nishimura M et al.; The auxotypes of 592 strains of Neisseria gonorrhoeae isolated in Sapporo between 1980 and 1989 were investigated . The serotypes of some of these strains were also studied, and the relation between the auxotype and the sensitivity to Amoxicillin (AMPC) was analyzed . The results were as follows . 1 . The auxotypes of Neisseria gonorrhoeae isolated in Sapporo were similar to those distributed in Southeast Asia . 2 . In a study of the auxotypes by year, the frequency of proto and Pro- decreased, while the frequency of AHU- increased . 3 . The serotypes of all strains of Neisseria gonorrhoeae investigated were WII/WIII, there was no WI serotype . 4 . With respect to the relation between auxotypes and sensitivity to AMPC, the AHU- strains were more sensitive than proto or Pro-.

Diagn Microbiol Infect Dis, 1990 Nov-Dec, 13(6), 499 - 507
Interpretive criteria, quality control guidelines, and drug stability studies for susceptibility testing of cefotaxime, cefoxitin, ceftazidime, and cefuroxime against Neisseria gonorrhoeae; Jones RN et al.; Cefotaxime, cefoxitin, ceftazidime, and cefuroxime were tested in a multicenter study to establish susceptibility testing criteria and quality control guidelines for Neisseria gonorrhoeae . Interpretive criteria were established by using triplicate testing of at least 100 gonococcal strains having various susceptibility patterns to currently utilized drug regimens . Only a susceptible category was proposed for cefotaxime and ceftazidime (greater than or equal to 31 mm and less than or equal to 0.5 micrograms/ml) because of rare resistant isolates . The other interpretive crtieria were cefoxitin susceptible, greater than or equal to 28 mm (less than or equal to 2 micrograms/ml); intermediate, 24-27 mm (4 micrograms/ml), and resistant, less than or equal to 23 mm (greater than or equal to 8 micrograms/ml); cefuroxime-susceptible, greater than or equal to 31 mm (less than or equal to 1 micrograms/ml); moderately susceptible, 26-30 mm (2 micrograms/ml); and resistant, less than or equal to 25 mm (greater than or equal to 4 micrograms/ml) . Quality control criteria were established by using multiple agar lots, three disk lots, and a number of replicates consistent with National Committee for Clinical Laboratory Standards M23-T guidelines.

Int J STD AIDS, 1990 Nov, 1(6), 405 - 9
Sexually transmitted diseases and rape: the experience of a sexual assault centre; Lacey HB; Epidemiological data and rates of sexually transmitted diseases (STDs) are presented from a group of 90 women screened following rape . Forty-eight (53%) women knew their assailant . In 6 cases multiple assailants were involved . In 21 (23%) rapes weapons were used . Of 47 women examined within 48 hours of rape, 17 (36%) had evidence of genital trauma . Anal injury was common (8 of 11, 73%) in those reporting anal intercourse . Anal assault (17 of 90, 19%) and oral assault (16 of 90, 18%) commonly accompanied rape . STDs were diagnosed in 13 (14.4%) women, 3 having mixed infections . Neisseria gonorrhoeae was isolated in 2 women, Chlamydia trachomatis in 7, Trichomonas vaginalis in 6, genital warts in 2 and Pediculosis pubis in 2 women . Five of 16 cervical cytology results showed abnormalities, 2 were suggestive of CIN . Eleven of 13 women with an STD (84.6%) had been sexually active within the 3 months prior to the rape . Previous sexual activity may be the most relevant factor determining those most at risk of harbouring an STD.

Mol Gen Genet, 1990 Oct, 224(1), 101 - 10
Cloning and characterization of two tandemly arranged DNA methyltransferase genes of Neisseria lactamica: an adenine-specific M.NlaIII and a cytosine-type methylase; Labbe D et al.; The gene encoding the Neisseria lactamica III DNA methyltransferase (M.NlaIII) which recognizes the sequence CATG has been cloned and expressed in Escherichia coli . DNA sequencing of a 3.125 kb EcoRI-PstI fragment localizes the M . NlaIII gene to a 334 codon open reading frame (ORF) and identifies, 468 bp downstream, a second ORF of 313 amino acids, which is referred to as M.NlaX . Both proteins are detectable in the E . coli coupled in vitro transcription-translation system; they are apparently expressed from separate N . lactamica promoters . The N-terminal half of the previously characterized M.FokI, which methylates adenine in one of the DNA strands with its asymmetric recognition sequence (GGATG), is found to have 41% sequence identity and a further 11.7% sequence similarity with M.NlaIII . Among the conserved amino acids is the wellknown DPPY sequence motif . With one exception, analysis of the nucleotides coding for the DP dipeptide in all known DPPY sequences shows the presence of an inherent DNA adenine methylation (dam) recognition site of GATC . A low level of expression of M.NlaX in E . coli prevents the elucidation of its sequence recognition specificity . Sequence analysis of M.NlaX shows that it is closely related to the group of monospecific 5-methylcytosine DNA methyltransferases (M.EcoRII, Dcm, M.HpaII and M.HhaI) which all have a modified cytosine at the second position of the recognition sequences . Both M.EcoRII and Dcm amino acid sequences are about 50% identical with M.NlaX; a considerable degree of sequence identity is found in the so-called variable region which is believed to be responsible for sequence recognition specificity . M.NlaX is probably the counterpart to the E . coli Dcm in N . lactamica.

Sex Transm Dis, 1990 Oct-Dec, 17(4), 181 - 3
Treatment of uncomplicated gonococcal urethritis with single-dose ceftizoxime; Goldstein AM et al.; In areas such as Los Angeles, California, where penicillin-resistant Neisseria gonorrhoeae accounts for 1% or more of all gonorrhea strains isolated, third-generation cephalosporin agents have replaced penicillin as standard therapy . Ceftriaxone, the agent recommended by CDC guidelines, or ceftizoxime, an alternative agent have excellent activity against all strains of N . gonorrhoeae . One hundred seventy-five male patients with clinically and microbiologically confirmed gonococcal urethritis were treated with single-dose ceftizoxime 250 mg IM (50 patients) or 500 mg IM (125 patients) . Cure was demonstrated clinically by repeat cultures of urethral discharge in all patients, including those with infections from penicillinase-producing strains of bacteria . None of the patients experienced complications or allergic reactions to ceftizoxime . Given the lower unit-of-use cost of ceftizoxime, its routine in place of ceftriaxone could result in substantial cost savings in those institutions that treat large numbers of patients with uncomplicated gonococcal urethritis.

Genitourin Med, 1990 Oct, 66(5), 361 - 6
Screening for cervical Chlamydia trachomatis infections in two Dutch populations; Thewessen EA et al.; Endocervical cultures for Chlamydia trachomatis and Neisseria gonorrhoeae were taken from 492 women attending an outpatient clinic for sexually transmitted diseases (group I) and 560 women seeking legal abortion (group II) . Possible risk factors for C trachomatis infection were evaluated by multivariate analysis . The prevalence rates for C trachomatis and N gonorrhoeae were 7.3% and 2.5% in group I and 9.4% and 0.4% in group II . From multivariate analysis it was found that age (p less than 0.01), number of sexual partners (p less than 0.01), abnormal vaginal discharge (p less than 0.01), and endocervical mucopus (p = 0.02) were independently associated with chlamydial infection in group I . In the abortion clinic age (p = 0.03) and endocervical mucopus (p = 0.03) were the only significant independent predictors of C trachomatis . In all women vaginal discharge was collected for Gram staining . A significant higher number of polymorphonuclear cells was seen in the smears of C trachomatis positive women (group I: p = 0.04; group II: p = 0.03) . In group II there was also a significant association between C trachomatis and Gardnerella type bacterial flora (p = 0.02) and the presence of comma-shaped rods (p = 0.04) . Screening for C trachomatis infection may help to decrease the incidence of (post-abortal) pelvic inflammatory disease . Because screening in abortion clinics is not always possible, decreasing the incidence of postabortal pelvic inflammatory disease could be achieved by using prophylactic antibiotics . Selective use of prophylaxis in high risk patients can minimise costs and the incidence of side effects.

Sex Transm Dis, 1990 Oct-Dec, 17(4), 211 - 5
Trends in sexually transmitted diseases in homosexually active men in King County, Washington, 1980-1990; Handsfield HH et al.; Trends in sexually transmitted diseases (STDs) in homosexually active men were analyzed in King County, Washington, from 1980 to 1990 . New-problem visits to the public STD clinic declined from 4142 in 1980 to 509 in 1988 (-88%), then rose to 937 (+84%) in 1989, and 527 in the first half of 1990 . Cases of gonorrhea in homosexually active men treated at the STD clinic plus private sector cases of rectal gonorrhea in men fell from 955 in 1982 to 33 in 1988 (-97%), then rose to 102 in 1989 (+209%) . Similar trends were observed for several other STDs . Of 109 Neisseria gonorrhoeae isolates from homosexual or bisexual men in 1988 to 1989, 46 (42%) belonged to 3 auxotype/serovar classes; one of these was a penicillinase-producing strain (PPNG), the first appearance of PPNG in substantial numbers in homosexually active men in King County . The remaining 58% of isolates were distributed among 20 strains . These data imply substantial reductions in the frequency of high-risk sexual behavior in homosexually active men in King County over most of the 1980s, followed by an increased frequency of unsafe behavior after 1988 . Maintenance of sexual safety may require increased educational effort and societal support as time passes.

Sex Transm Dis, 1990 Oct-Dec, 17(4), 175 - 80
Penicillin resistant Neisseria gonorrhoeae in low prevalence areas: implications for cost-effective management; Nettleman MD et al.; Though ampicillin is no longer recommended as first-line therapy for infections caused by Neisseria gonorrhoeae, the cost and efficacy of this policy in low prevalence areas has not been investigated . The problem was highlighted by an outbreak of penicillin-resistant N . gonorrhoeae in an area where the proportion of resistance had previously been only 0.14% . A decision analysis was performed to determine the cost-effectiveness of beta-lactamase screening and alternative therapies for patients attending sexually transmitted diseases clinics . Empiric therapy with an inexpensive agent active against resistant strains, such as ciprofloxacin, was the most cost-effective approach and remained more cost-effective than alternative strategies whenever the proportion of resistant isolates exceeded 3% . Ceftriaxone was less cost-effective . In low prevalence areas, and in areas where the return rate of recalled patients is high, ampicillin therapy was cost-effective, but beta-lactamase screening should be performed routinely.

J Antimicrob Chemother, 1990 Oct, 26 Suppl B, 141 - 6
Pefloxacin compared with cefotaxime for treating men with uncomplicated gonococcal urethritis; Tio TT et al.; In a randomized comparative study, 83 male patients suffering from acute uncomplicated gonococcal urethritis were treated with a single dose of either 0.8 g pefloxacin, given orally, or 1.0 g cefotaxime, given intramuscularly . The cure rates were 100% in both treatment groups four to seven days and 21 to 31 days, respectively, after therapy . The MICs of the isolated Neisseria gonorrhoeae ranged from 0.008 to 0.06 mg/l for pefloxacin and from 0.0005 to 0.03 mg/l for cefotaxime . Postgonococcal urethritis was found in 9% of the patients treated with pefloxacin and in 20% of the patients treated with cefotaxime . Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum were isolated from 15%, 7% and 22% of the patients, respectively, before therapy and from 22%, 11% and 20% of the patients, respectively, 21 to 31 days after therapy . Both antibiotics had no effect on the presence of these microorganisms . No side effects were recorded in either groups of patients except that 46% of the patients treated with cefotaxime reported mild pain at the injection site . In conclusion, pefloxacin and cefotaxime are safe and effective agents in the treatment of uncomplicated gonococcal urethritis in men.

Genitourin Med, 1990 Oct, 66(5), 351 - 6
Penicillin and cephalosporin resistance in gonococci; Ison CA et al.; Non-penicillinase producing Neisseria gonorrhoeae isolated at St Mary's Hospital, London were examined for the prevalence of resistance to penicillin and for decreased susceptibility to cefuroxime . Of the 941 non-PPNG tested 100 (10.6%) were resistant to penicillin (minimum inhibitory concentration, MIC, greater than or equal to 1 mg/l) and were considered to be chromosomally-resistant N gonorrhoeae (CMRNG) . Decreased susceptibility to cefuroxime (MIC, greater than or equal to 0.5 mg/l) was detected in 79% of the CMRNG . The CMRNG were also more often prototrophic and of serogroup IB than the remaining non-PPNG . The correlation coefficient for resistance to penicillin and cefuroxime was high, 0.79 . Transformation experiments with both genetically-defined strains and transformants obtained using DNA from clinical isolates, showed that increased resistance to cephalosporins was acquired in three steps in close association with penicillin . We think this suggests that the loci controlling resistance to the cephalosporins are identical or closely linked to those controlling penicillin resistance.

APMIS, 1990 Oct, 98(10), 954 - 6
Minimal criteria for identification of Moraxella (Branhamella) catarrhalis; Jonsson I et al.; A study was performed which aimed at testing the reliability of our routine diagnostic tests for identification of Moraxella (Branhamella) catarrhalis in clinical samples from the respiratory tract . A preliminary diagnosis of 122 isolates as Moraxella catarrhalis was obtained by using colony morphology and results of Gram stain and oxidase test as the sole diagnostic criteria . By using additional tests we could show that the preliminary diagnosis was incorrect for 21 isolates, which were classified as different Neisseria species . 20 of these were isolated from sputum samples . We propose that at least a test for DNA hydrolysis should be included in the routine procedure for identification of Moraxella catarrhalis in sputum.

J Clin Microbiol, 1990 Oct, 28(10), 2349 - 50
DNA probe confirmatory test for Neisseria gonorrhoeae; Lewis JS et al.; A DNA probe test for the culture confirmation of Neisseria gonorrhoeae in clinical isolates was evaluated with 156 isolates of N . gonorrhoeae and 120 isolates of nongonococcal Neisseria species, organisms representative of other genera within the family Neisseriaceae, and organisms isolated on media selective for N . gonorrhoeae . The 30-min test used a chemiluminescent DNA probe that was homologous to rRNA sequences of N . gonorrhoeae . We report here a specificity and a sensitivity of 100% with the 276 clinical isolates tested, including 43 gonococcal strains that had been misidentified by other methods.

J Clin Microbiol, 1990 Oct, 28(10), 2347 - 8
Butyrate esterase (4-methylumbelliferyl butyrate) spot test, a simple method for immediate identification of Moraxella (Branhamella) catarrhalis {corrected}; Perez JL et al.; A total of 47 Moraxella (Branhamella) catarrhalis strains, 89 strains of Neisseria spp., and 82 strains of miscellaneous bacteria and yeasts were studied by using a fluorogenic spot method which detects butyrate esterase . A positive butyrate esterase spot test correctly differentiated M . catarrhalis from Neisseria spp., which had a negative butyrate esterase spot test reaction . The test is rapid, simple, and easy to perform . The butyrate esterase spot test was useful for direct identification of M . catarrhalis from primary cultures . However, false-positive reactions may occur with mixed cultures.

Clin Microbiol Rev, 1990 Oct, 3(4), 293 - 320
Branhamella catarrhalis: an organism gaining respect as a pathogen; Catlin BW; Branhamella catarrhalis was formerly regarded as a common, essentially harmless inhabitant of the pharynx . This misapprehension was caused, in part, by confusion with another pharyngeal resident, Neisseria cinerea . The two organisms can now be differentiated by the positive reactions of B . catarrhalis in tests for nitrate reduction and hydrolysis of tributyrin and DNase . B . catarrhalis is currently recognized as the third most frequent cause of acute otitis media and acute sinusitis in young children . It often causes acute exacerbations of chronic bronchopulmonary disease in older or immunocompromised adults and is incriminated occasionally in meningitis, endocarditis, bacteremia, conjunctivitis, keratitis, and urogenital infections . Virulence-associated factors, such as pili, capsules, outer membrane vesicles, iron acquisition proteins, histamine-synthesizing ability, resistance to the bactericidal action of normal human serum, and binding to the C1q complement component, have been identified in some strains . beta-Lactamase producing strains, first detected in 1976, have risen to approximately 75% worldwide . Thus far, however, practically all American strains of B . catarrhalis remain susceptible to alternative antibiotics . A possible selective advantage of recent isolates is their reportedly heightened tendency for adherence to oropharyngeal cells from patients with chronic bronchopulmonary disease.

Gene, 1990 Sep 28, 94(1), 139 - 40
Sequence of the argF gene encoding ornithine transcarbamoylase from Neisseria gonorrhoeae; Martin PR et al.; The gonococcal argF gene encoding ornithine transcarbamoylase (OTCase) contains an open reading frame of 993 nucleotides which starts with a GUG codon and encodes a peptide with a deduced Mr of 36,731 . We compared the predicted amino acid (aa) sequence to OTCase sequences previously determined for Escherichia coli and Pseudomonas aeruginosa and found that highly conserved regions in the genes from these organisms were also conserved in Neisseria gonorrhoeae, including those aa known to be important for carbamoyl phosphate and ornithine binding . In the flanking regions of the gene were found 15-bp inverted repeats that may serve as transcriptional termination signals, and which contain the neisserial DNA-uptake sequence.

JAMA, 1990 Sep 19, 264(11), 1413 - 7
National surveillance of antimicrobial resistance in Neisseria gonorrhoeae . The Gonococcal Isolate Surveillance Project; Schwarcz SK et al.; The Gonococcal Isolate Surveillance Project is a national sentinel surveillance system to estimate levels and monitor trends of antimicrobial resistance in prospectively collected isolates of Neisseria gonorrhoeae . Of 6204 isolates evaluated from 21 clinic sites between September 1987 and December 1988, 21% met at least one of the surveillance criteria for resistance to penicillin, tetracycline, cefoxitin, or spectinomycin; 2.2% were penicillinase-producing N gonorrhoeae; 1.0% had high-level plasmid-mediated tetracycline resistance; and 16.8% of the isolates without plasmid-mediated resistance had chromosomally mediated resistance (defined as a minimum inhibitory concentration greater than or equal to 2 micrograms/mL) to penicillin, tetracycline, or cefoxitin . Three isolates were resistant to spectinomycin . All isolates were susceptible to ceftriaxone . Resistant isolates were identified from all participating centers . Patient demographic and behavioral characteristics were not predictive of infections caused by resistant organisms . These results demonstrate the wide distribution of antimicrobial-resistant N gonorrhoeae and support recent changes in Centers for Disease Control therapy recommendations for gonococcal infections that no longer recommend tetracycline and penicillin as first-line therapies.

Arthritis Rheum, 1990 Sep, 33(9), 1438 - 41
Gonococcal pericarditis with tamponade in a patient with systemic lupus erythematosus; Coe MD et al.; Pericarditis is one of the most frequent manifestations of systemic lupus erythematosus; however, purulent pericarditis and tamponade are rare . We describe a patient with systemic lupus erythematosus and culture-proven gonococcal arthritis who developed purulent pericarditis with intracellular gram-negative diplococci . Evidence of tamponade was seen on echocardiography . There has not been a reported case of Neisseria gonorrhoeae in pericardial fluid or tissue since the introduction of antibiotics.

J Rheumatol, 1990 Sep, 17(9), 1240 - 1
Septic olecranon bursitis caused by Neisseria sicca; Halla JT; A man with rheumatoid arthritis developed a septic olecranon bursitis due to Neisseria sicca . This case confirms the potential pathogenicity of Neisseria sicca and emphasizes that positive cultures for this organism should not be readily dismissed.

J Antimicrob Chemother, 1990 Sep, 26 Suppl A, 37 - 43
Comparison of cefotaxime, cefoxitin and clindamycin plus gentamicin in the treatment of uncomplicated and complicated pelvic inflammatory disease; Martens MG et al.; Patients with uncomplicated pelvic inflammatory disease (PID) (acute salpingitis and no pelvic masses) were randomly assigned for treatment with either cefotaxime or cefoxitin . A clinical cure was achieved in 17 of 20 cases (82%) and 19 of 22 cases (84%), respectively . Within the complicated PID group, patients were assigned to two subgroups: those with a tubo-ovarian complex (26 patients), and those with a tubo-ovarian abscess (32 patients), as confirmed by ultrasonography or surgery . Patients within each of these two subgroups were then randomly assigned for treatment with either cefotaxime or clindamycin plus gentamicin . Within the tubo-ovarian complex subgroup, a clinical cure was achieved in 11 of 13 cases (85%) treated with cefotaxime and 10 of 13 cases (77%) treated with clindamycin plus gentamicin . Within the tubo-ovarian abscess subgroup, a clinical cure was achieved in 12 of 16 cases (75%) treated with cefotaxime and 11 of 16 cases (69%) treated with clindamycin plus gentamicin . No differences in any category were statistically significant . Specimens for culture were obtained from the endocervix, endometrium, and when possible, the cul-de-sac, fallopian tubes, and abscess . Neisseria gonorrhoeae (33%) was isolated more frequently than Chlamydia trachomatis (12%) in patients with PID, and neither of these organisms was isolated with any increased frequency in patients with complicated PID . The majority of the patients were considered to have polymicrobial infection . Cefotaxime was as efficacious as cefoxitin and clindamycin plus gentamicin for the treatment of acute salpingitis, tubo-ovarian complex and tubo-ovarian abscess.

J Antimicrob Chemother, 1990 Sep, 26 Suppl A, 23 - 7
Treatment of gonococcal conjunctivitis with a single intramuscular injection of cefotaxime; Lepage P et al.; Between 25% and 50% of children in African countries are exposed to Neisseria gonorrhoeae at birth and are at risk of developing gonococcal ophthalmia neonatorum . The problem is aggravated by the emergence of penicillinase-producing strains of N . gonorrhoeae (PPNG) . Twenty-one children (9 boys, 12 girls, mean age 13 days) presenting with gonococcal conjunctivitis were identified during a 47-month period . Nineteen children received a single im injection of 100 mg/kg cefotaxime (maximum dose 1 g) without topical antibiotic therapy . One neonate with concurrent otitis media was treated with cefotaxime for five days and a 17-month old girl received two im injections because of the severity of her symptoms . Eight patients (38%) had received previous antibiotic therapy (penicillin im and/or tetracycline eye ointment) . Twelve isolates of N . gonorrhoeae were found to be PPNG strains . At three to seven day follow-up examination all 21 patients were clinically cured without residual eye damage . Cefotaxime offers an effective first line treatment for gonococcal ophthalmia neonatorum in areas where there is a high prevalence of PPNG strains . The advantages of a single-dose treatment over multidose regimens in terms of compliance and cost are discussed.

J Neuroimmunol, 1990 Sep-Oct, 29(1-3), 49 - 56
Evidence for autoimmune antibodies directed against embryonic neural cell adhesion molecules (N-CAM) in patients with group B meningitis; Nedelec J et al.; Human brain tissue shares alpha 2-8 linked polymers of neuraminic acid with the carbohydrates expressed on the capsule of group B Neisseria meningitidis bacteria (Finne et al . (1983) Lancet ii, 355-357; Finne (1985) Trends Biochem . Sci . 10, 129-132; Rougon et al . (1986) J . Cell . Biol . 103, 2429-2437) . We report that sera from patients suffering from group B meningitis exhibited IgM antibodies directed against the embryonic, but not the adult, form of neural cell adhesion molecules (N-CAM) . These sera also stained live ATt20 cells as well as neuron membranes in mouse embryonic brain cultures . We have demonstrated that such antibodies, directed against carbohydrate moieties of bacterial capsula, were able to lyse cells expressing embryonic N-CAM in a complement-dependent cytotoxic assay . These data infer (1) that humans are able to develop anti-MenB humoral responses, (2) that such responses could initiate autoimmune disorders or be potentially detrimental by interfering with processes mediated by N-CAM interactions, (3) that the development of a vaccine against group B meningitidis should be considered with caution.

J Bacteriol, 1990 Sep, 172(9), 5225 - 35
Genetic evidence that Neisseria gonorrhoeae produces specific receptors for transferrin and lactoferrin; Blanton KJ et al.; Transferrin (TF) and lactoferrin (LF) are probably the major sources of iron (Fe) for Neisseria gonorrhoeae in vivo . We isolated mutants of N . gonorrhoeae FA19 that were unable to grow with Fe bound to either TF (TF-) or LF (LF-) or to both TF and LF ({TF LF}-) . The amount of Fe internalized by each of the mutants was reduced to background levels from the relevant iron source(s) . The wild-type parent strain exhibited saturable specific binding of TF and LF; receptor activity was induced by Fe starvation . The TF(-)-specific or LF(-)-specific mutants were almost completely lacking in receptor activity for TF or LF, respectively, whereas the {TF LF}- mutants bound both TF and LF as well as the wild-type strain . All mutants utilized citrate and heme normally as Fe sources . These results demonstrate that ability to bind TF or LF is essential for gonococci to scavenge appreciable amounts of Fe from these sources in vitro . In addition, the TF and LF Fe acquisition pathways are linked by the mutual use of a nonreceptor gene product that is essential to Fe scavenging from both of these sources; this gene product is not required for Fe acquisition from other sources.

Int J STD AIDS, 1990 Sep, 1(5), 343 - 5
Antimicrobial susceptibility of non-penicillinase and penicillinase-producing Neisseria gonorrhoeae strains isolated in Tripoli, Libya; Elghoul MT et al.; Neisseria gonorrhoeae culture gave a positive result in 42 of 64 male adults with purulent urethral discharge . The majority of the infections were acquired outside Libya . Twenty-seven strains (64.3%) were non-penicillinase producing (NPPNG) and 15 (35.7%) were penicillinase producing (PPNG) by starch paper technique . Antimicrobial susceptibility of the strains to 5 antibiotics was carried out by agar-plate dilution technique . Twenty-three NPPNG strains (54.8%) were susceptible to penicillin with a minimum inhibitory concentration (MIC) of less than or equal to 0.5 micrograms/ml . In 4 strains (9.5%), a high resistance to penicillin (MIC greater than or equal to 16 micrograms/ml) appeared to be chromosomally-mediated (CMRNG) . All PPNG strains were resistant to penicillin (MIC greater than or equal to 1 microgram/ml) . While resistance to erythromycin (MIC greater than or equal to 1 microgram/ml) and tetracycline (MIC greater than or equal to 1 microgram/ml) was observed in 5 strains, resistance to kanamycin (MIC 32 micrograms/ml) and spectinomycin (MIC 64 micrograms/ml) was present in only one strain . Whereas no significant differences were recorded in MICs of erythromycin, tetracycline, kanamycin and spectinomycin between NPPNG and PPNG strains, one PPNG strain was found to be resistant in vitro to all 5 antibiotics.

Int J STD AIDS, 1990 Sep, 1(5), 340 - 2
Is coexisting chlamydial infection more common in gonococcal infections with serogroup WI?
McKenna JG, Young H, Moyes A, Smith IW.
Over a 4-year period a total of 8974 women were screened for Neisseria gonorrhoeae and Chlamydia trachomatis . There were 489 cases of cervical gonorrhoea, 261 serogroup WI and 228 serogroup WII/III . A total of 169 (34.6%) cases had a dual infection with C . trachomatis, 92 from the WI serogroup and 77 from the WII/III . Using Fisher's exact test, no statistically significant difference was observed in the rates of chlamydial carriage between the two serogroups (P = 0.39) . These findings are at odds with previously reported data, which suggested a biological interaction resulting in a positive correlation between colonization with serogroup WI and C . trachomatis . Possible reasons for the difference between the findings are discussed.

FEMS Microbiol Lett, 1990 Sep 1, 59(1-2), 49 - 54
Analysis of the expression of outer-membrane proteins in Neisseria meningitidis in iron-replete and iron-deficient media; Ferreiros CM et al.; A total of 103 Neisseria strains, including 42 carrier and 40 invasive N . meningitidis and 21 commensal species were studied . Outer-membrane proteins from carrier and invasive N . meningitidis showed similar molecular mass distributions (except in the range from 78 to 82 kDa in which 90% of the invasive but only 47.6% of the carrier strains expressed proteins), many strains showing neither class II (41 kDa) nor class III (38 kDa) proteins . When grown in iron-restricted conditions proteins were induced mainly in the ranges from 62 to 92 kDa with no significant differences between groups . Commensal species, both in normal and in iron-restricted conditions, showed outer-membrane protein patterns different from those of N . meningitidis in several molecular mass ranges . Cluster analysis based on expression of principal outer-membrane proteins allowed the differentiation of commensal species and N . meningitidis, although not that of the invasive and carrier groups within the latter.

Eur J Epidemiol, 1990 Sep, 6(3), 323 - 5
The occurrence of Branhamella catarrhalis and other commensal Neisseriaceae in clinical sputum specimens in Lagos, Nigeria; Obi MC et al.; Branhamella catarrhalis and other commensal Neisseria species were isolated from 200 out of 500 sputum samples from patients with lower respiratory tract (LRT) infections at the Lagos University Teaching Hospital (LUTH) . B . catarrhalis was isolated from 60 (12%) . The isolation rates for other Neisseria species were as follows: N . mucosa from 45 (9%), N . sicca from 40 (8%), N . lactamica from 35 (7%), N . cinerea from 12 (2.4%) and N . subflava from 8 (1.6%) . B . catarrhalis occurred in pure cultures in 15 (25%) of the 60 samples positive for this organism . Twenty (33%) out of the 60 N . catarrhalis isolates were beta-lactamase positive.

J Clin Microbiol, 1990 Sep, 28(9), 2134 - 5
False-positive latex agglutination test for Neisseria meningitidis groups A and Y caused by povidone-iodine antiseptic contamination of cerebrospinal fluid; D'Amato RF et al.; The cerebrospinal fluid of a patient yielded a positive latex agglutination test for Neisseria meningitidis groups A and Y . The latex agglutination results were not consistent with clinical and other laboratory findings . An investigation determined that the positive agglutination test was caused by contamination of the cerebrospinal fluid with povidone-iodine during the lumbar puncture.

J Clin Microbiol, 1990 Sep, 28(9), 2099 - 100
Evaluation of two commercial procedures for rapid identification of Neisseria gonorrhoeae using a reference panel of antigenically diverse gonococci; Boehm DM et al.; Two commercial tests for the rapid identification of Neisseria gonorrhoeae were evaluated . Two hundred seventy-nine organisms were tested, including 202 strains of N . gonorrhoeae . The Syva MicroTrak test results were less subjective but required a fluorescence microscope . The Phadebact Monoclonal GC OMNI Test required modification of the manufacturer's interpretive instructions in order to avoid cross-reactions, but it was a practical test . Specificities of both tests were 100% . Sensitivities of the Phadebact Monoclonal GC OMNI and Syva MicroTrak tests were 100% and approximately 100%, respectively.

Gene, 1990 Sep 1, 93(1), 151 - 6
Nucleotide sequence and expression in Escherichia coli of the recA gene of Neisseria gonorrhoeae; Fyfe JA et al.; The nucleotide sequence of the recA gene of Neisseria gonorrhoeae MS11 has been determined . The product of this gene can act as a recombinase in Escherichia coli, but does so with a decreased efficiency, probably because of the formation of mixed multimers with the equivalent E . coli protein.

Infect Immun, 1990 Sep, 58(9), 2777 - 84
Up-regulation of human neutrophil receptors for Neisseria gonorrhoeae expressing PII outer membrane proteins; Farrell CF et al.; In the absence of serum, nonpiliated gonococci expressing PII outer membrane proteins (PIIs) adhere to human neutrophils whereas non-PII-expressing (PII-) gonococci do not . After an observation that neutrophils in monolayers bound more gonococci than neutrophils in suspension, we treated neutrophil suspensions with known stimulants of degranulation and measured subsequent gonococcal adherence to suspended neutrophils . The chemotactic peptide N-formyl-methionyl-leucyl-phenylalanine (fmlp), the potent secretagogue phorbol myristate acetate, and the calcium ionophore A23187 all caused increased adherence of PII+ gonococci, but not PII- gonococci, to neutrophils in a dose-responsive manner . Increased adherence of gonococci to neutrophils was paralleled by increased degranulation of neutrophil myeloperoxidase, lysozyme, and lactoferrin . Inhibition of fmlp-induced neutrophil degranulation by pertussis toxin, the calmodulin inhibitors trifluoperazine and N-5-chloronaphthalene sulfonamide, or the intracellular calcium-binding agent trimethoxybenzoic acid also inhibited fmlp-induced gonococcal adherence to neutrophils . Neither undifferentiated nor myelocytically differentiated HL-60 cells, which possess primary but defective or nonexistent secondary granules, bound PII+ or PII- gonococci . Gonococci did not adhere to human monocytes, monocyte-derived macrophages, lymphocytes, platelets, or erythrocytes, indicating that several receptors, such as the complement receptors CR1, CR3 (CD11b/CD18), and CR4 (CD11c/CD18) or the adherence complex LFA-1 (CD11a/CD18), were probably not involved in gonococcal adherence to human neutrophils.

FEBS Lett, 1990 Aug 20, 269(1), 79 - 82
FITC-labeled lipopolysaccharide: use as a probe for liposomal membrane incorporation studies; Trubetskoy VS et al.; FITC-labeled LPS from Neisseria meningitidis can be used as a probe to follow the process of LPS incorporation into liposomal membrane and to study its interaction with a bilayer . The incorporation of FITC-LPS into the bilayer was proved by physicochemical methods as well as by liposomal LPS toxicity decrease in actinomycin D-sensitized mice . Fluorescence intensity increase was observed upon the insertion of FITC-LPS into the membrane of dehydration/rehydration vesicles and vesicles obtained by co-sonication of lipid suspension and FITC-LPS . Following FITC-LPS fluorescence polarization it was shown that the substance seems to be clusterized in the liposomal membrane starting from FITC-LPS/lipid molar ratio 1:800.

S Afr Med J, 1990 Aug 18, 78(4), 189 - 91
A microbiological study of failed penicillin therapy for gonococcal urethritis in Durban; Hoosen AA et al.; Seventy-five men presenting with persistent urethral discharge after penicillin therapy were investigated for sexually transmitted pathogens during July - September 1987 . The major aetiological agent isolated was Neisseria gonorrhoeae (58 patients (77.3%} . Penicillinase-producing N . gonorrhoeae (PPNG) accounted for 58.6% of 58 isolates . Chlamydia trachomatis was detected in 10.7% of patients and Trichomonas vaginalis in 14.7% of patients . When there is a high prevalence of PPNG, the use of penicillin as a first-line agent for therapy should be discontinued in favour of an agent active against PPNG and non-PPNG strains . Furthermore, in view of the relatively high prevalence of T . vaginalis, patients returning with persistent urethral discharge should be investigated and treated for infection with this protozoan.

S Afr Med J, 1990 Aug 18, 78(4), 187 - 9
Efficacy of various single-dose regimens of ceftriaxone in uncomplicated acute gonococcal urethritis in adult males; Hoosen AA et al.; The therapeutic efficacy of single intramuscular doses of ceftriaxone (Rocephin; Roche) (62.5, 125 and 250 mg), administered without probenecid, was evaluated in 167 adult males with uncomplicated acute gonococcal urethritis . Cure rates of 100% were achieved at 62.5 mg and 250 mg . In the 125 mg dose group, Neisseria gonorrhoeae was isolated from 1 patient at follow-up after therapy . Reinfection was suspected, since this patient returned on day 10 and admitted to sexual contact 2 days previously . Side-effects were minimal, and patient acceptance was better for ceftriaxone dissolved in lignocaine than in sterile water . Chlamydia trachomatis was detected at follow-up in 14.4% patients, confirming that ceftriaxone has no significant effect on chlamydial infection and additional treatment is necessary for patients with coexistent infection.

Nature, 1990 Aug 16, 346(6285), 671 - 4
Molecular cloning and overexpression of the human FK506-binding protein FKBP; Standaert RF et al.; The potent immunosuppressive agent FK506 is highly effective in preventing organ transplant rejection in humans . Like cyclosporin A, FK506 inhibits the transcription of early T-cell activation genes, apparently by modulating the activity of transcriptional regulators such as nuclear factor of activated T cells . A remarkable finding is that the predominant binding proteins (immunophilins) for cyclosporin A and FK506, cyclophilin and FKBP respectively, are peptidyl-prolyl-cis-trans-isomerases that are potently and selectively inhibited by their respective ligands . Here we report the complementary DNA and derived amino-acid sequences of human FKBP from Jurkat cells and also the efficient overexpression in Escherichia coli of fully active, recombinant human FKBP . The human FKBP cDNA sequence shows significant similarity to an open reading frame in the Neisseria meningitidis genome.

J Biol Chem, 1990 Aug 15, 265(23), 13584 - 8
Identification of the primary antimicrobial domains in human neutrophil cathepsin G; Bangalore N et al.; Lysosomal cathepsin G from human neutrophils is a chymotrypsin-like protease which also possesses antimicrobial activity . The antimicrobial activity, however, is independent of protease activity, because treatment of this enzyme with the irreversible serine protease inhibitor diisopropylfluorophosphate has no effect on its antimicrobial action . In this study, we found that digestion of cathepsin G with clostripain caused a loss of proteolytic activity in this neutrophil proteinase . However, bactericidal activity in in vitro assays against Staphylococcus aureus and Neisseria gonorrhoeae was retained . Fractionation of the clostripain-digested cathepsin G mixture yielded two distinct antimicrobial peptides . The sequences of these peptides were IIGGR and HPQYNQR (residues 1-5 and 77-83 in cathepsin G, respectively) . Synthetic peptides corresponding to these sequences were also prepared and found to exert broad-spectrum antimicrobial activity in vitro, displaying conditions of temperature- and pH-dependent optima for antimicrobial action resembling that of the full-length enzyme . Depending on the target bacterial strain, these peptides exhibited antimicrobial activity between 5.0 x 10(-5) and 4.0 x 10(-4) M . Significantly, replacement of certain residues within these peptides with either alanine or valine significantly reduced their antibacterial capacities . Our studies suggest that cathepsin G has two antimicrobial sequences, either or both of which may contribute to its bactericidal activity.

J Biol Chem, 1990 Aug 5, 265(22), 12774 - 7
Lacto- and ganglio-series glycolipids are adhesion receptors for Neisseria gonorrhoeae; Deal CD et al.; The role of glycolipids as adhesion receptors for Neisseria gonorrhoeae is examined . Serum-resistant isolates, piliated and nonpiliated isogenic variants, as well as gonococci deficient in lipooligosaccharide and protein II, bind specifically to terminal and internal GlcNAc beta 1-3Gal beta 1-4Glc and GalNAc beta 1-4Gal beta 1-4Gcl sequences in lacto- and ganglio-series glycolipids, respectively, as measured by overlaying glycolipid chromatograms with 125I-labeled organisms . The binding activity was not affected by changing the growth conditions of the organism, as the gonococci bound to both classes of glycolipids when grown anaerobically, microaerophilically on agar or in broth, or under iron-limited conditions . The gonococci do not bind to lacto-sylceramide (Gal beta 1-4Glc beta 1-1Cer) derived from lacto-N-triaosylceramide or from asialo-GM2 by treatment with N-acetyl-beta-hexosaminidase, or to other neutral glycolipids tested . Although N . gonorrhoeae bound weakly to some gangliosides on thin-layer chromatograms, including sialylparagloboside and GM1, in solid phase assays the gonococci bound with high avidity to the sequence GalNAc beta 1-4Gal beta 1-4Glc, with moderate avidity to the sequence GlcNAc beta 1-3Gal beta 1-4Glc, and not at all to gangliosides . Interestingly, the 4.8-kDa component of gonococcal lipooligosaccharide, which contains lacto-N-neotetraose (Gal beta 1-4GlcNAc beta 1-3Gal beta 1-4Glc), strongly inhibits gonococcal-specific agglutination of human erythrocytes and inhibits the binding of labeled organisms to human paragloboside and lacto-N-triaosylceramide on thin-layer chromatograms . Possibly, this binding specificity explains why gonococci autoagglutinate in vitro.

Genitourin Med, 1990 Aug, 66(4), 244 - 6
The prevalence of symptomatic sexually transmitted diseases and human immunodeficiency virus infection in outpatients in Lilongwe, Malawi; Kristensen JK; In June 1989 a pilot study on the prevalence of STDs was performed at Kamuzu Central Hospital, Lilogwe, Malawi . Among unselected out-patients an STD prevalence of 4.4% was found . The patients were predominantly males (82.7%), the age was predominantly 20-35 yr . The distribution of the diagnoses was dominated by a relatively large proportion of "ulcer-diseases" (syphilis, chancroid and lymphogranuloma venereum) making up 67% of the patients . Almost two thirds of the patients were HIV-positive (62.4%) . No significant difference was found in HIV-infection prevalence when patients with ulcer diseases were compared with patients with discharges . Among the patients with gonorrhoea a prevalence of penicillinase-producing Neisseria gonorrhoeae of 53% was found . It is concluded that a plan for the management of STDs is urgently needed as it is of paramount importance to combat STDs in order to prevent the spread of HIV-infectionPIP: In June 1989, a pilot study investigating the prevalence of sexually transmitted diseases (STDs) was conducted at Kamuzu Central Hospital, Lilongwe, Malawi . Among unselected outpatients, an STD prevalence of 4.4% was found . The patients were predominantly 20-35 years of age . The distribution of diagnoses was dominated by a relatively large proportion of ulcer diseases (syphilis, chancroid, and lymphogranuloma venereum), seen among 67% of the patients . Almost 2.3 of the patients were HIV-positive (62.4%) . No significant difference was found in HIV infection prevalence when patients with ulcer diseases were compared to patients with discharges . Among the patients with gonorrhea, a prevalence of penicillinase-producing Neisseria gonorrhoea of 53% was found . It is concluded that a plan for the management of STDs is urgently needed as it is of paramount importance in combatting STDS in order to prevent the spread of HIV infection . author's modified

Hum Pathol, 1990 Aug, 21(8), 831 - 7
Histopathology of endocervical infection caused by Chlamydia trachomatis, herpes simplex virus, Trichomonas vaginalis, and Neisseria gonorrhoeae; Kiviat NB et al.; We determined the histologic correlates of clinically identified mucopurulent cervicitis, culture-proven cervical infection with Chlamydia trachomatis, Neisseria gonorrhoeae, herpes simplex virus (HSV), and vaginal infection with Trichomonas vaginalis by examining cervical biopsies from 83 women . Clinical mucopurulent cervicitis and culture-documented infection with one or more of these pathogens correlated histologically with intraepithelial neutrophils, reactive endocervical cells, edema, luminal neutrophils, and with several deeper tissue changes such as extensive and dense subepithelial inflammation, granulation tissue, and necrotic ulceration . Focal loss of surface columnar cells and spongiosis were also correlated with culture-confirmed infection . Well-formed germinal centers were seen in biopsies from 14 of 21 patients (67%) with C trachomatis infection alone, but in none of 17 patients with infections other than C trachomatis (P less than 0.001) . A predominantly plasmacytic infiltrate was also significantly associated with chlamydial infection . Necrotic ulcers overlying a predominantly lymphocytic infiltrate were seen in six of nine patients (67%) with HSV infection alone but in only two of 40 patients (5%) with other infections (P less than 0.001) . Marked inflammatory changes were not seen in the patients infected with N gonorrhoeae . The organism T vaginalis was not associated with any endocervical pathology . If these results are confirmed by prospective studies, they suggest that pathologists should alert clinicians to the possibility of recent or current infection with C trachomatis or HSV when cervical biopsies show the above changes . The loss of surface columnar epithelium with HSV, chlamydial, and gonococcal infection offers a possible explanation for the reported association of these infections with increased risk of acquiring human immunodeficiency virus infection.

Clin Orthop, 1990 Aug, (257), 100 - 3
Mixed gonococcal and mycobacterial sepsis of the wrist; Rolfe B et al.; Mycobacterial infections of the hand and wrist are rare . Concurrent infection of a joint by more than one organism is also unusual . A 25-year-old man developed wrist sepsis caused by Neisseria gonorrhoeae and Mycobacterium avium intracellularis . The infection was successfully treated by wrist drainage, carpal debridement, and intravenous antibiotics . Secondary carpal reconstruction was accomplished by delayed bone grafting and internal fixation to preserve radiocarpal motion.

Infect Immun, 1990 Aug, 58(8), 2555 - 63
Erythrocyte gangliosides act as receptors for Neisseria subflava: identification of the Sia-1 adhesin; Nyberg G et al.; Neisseria gonorrhoeae was recently shown to bind to a subset of lactose-containing glycolipids (N . Stromberg, C . Deal, G . Nyberg, S . Normark, M . So, and K.-A . Karlsson, Proc . Natl . Acad . Sci . USA 85:4902-4906, 1988) . A number of commensal Neisseria strains were also shown to be lactose binders . In addition, Neisseria subflava bound to immobilized gangliosides, such as hematoside and sialosyl paragloboside, carrying the NeuAc alpha 2-3Gal beta 1-4Glc sequence . To a lesser extent, N . gonorrhoeae also bound to this receptor in vitro . In N . subflava GN01, this binding property mediated agglutination of human erythrocytes in a neuraminidase-sensitive fashion . Nitrosoguanidine-induced nonhemagglutinative mutants of N . subflava GN01 had lost the ability to bind hematoside and sialosylparagloboside but remained able to bind lactosylceramide and gangliotetraosylceramide . These mutants fell into three classes with respect to their outer membrane protein profiles in sodium dodecyl sulfate-polyacrylamide gel electrophoresis . Class 1 mutants were identical to the parent strain save for the loss of a 27-kilodalton (kDa) protein . Class 2 mutants showed an outer membrane protein profile identical to that of the wild type, whereas mutants belonging to class 3 showed a number of changes, including the apparent absence of the 27-kDa protein . The 27-kDa protein from N . subflava GN01 was purified from the supernatant . A polyclonal antiserum to the purified Sia-1 protein as well as a Sia-1-specific monoclonal antibody inhibited hemagglutination by strain GN01 . The purified Sia-1 protein in the presence of diluted anti-Sia-1 antiserum mediated a neuraminidase-sensitive hemagglutination . The purified Sia protein from a class 2 mutant was not able to hemagglutinate when cross-linked with antibodies, suggesting that it is a mutant form of Sia-1 affected in the receptor-binding site . Immunoelectron microscopy with a Sia-1-specific monoclonal antibody revealed that the adhesin was nonfimbrial in nature, with aggregates of the adhesin extended out from the cells in a patchy fashion.

Mol Microbiol, 1990 Aug, 4(8), 1293 - 301
Characterization of fourteen strains of Neisseria gonorrhoeae: structural analyses and serum reactivities; Pettit RK et al.; Resistance to normal human serum (NHS) killing in Neisseria gonorrhoeae has been associated with particular types of Protein I (PI) and lipopolysaccharide (LPS), but many exceptions exist, and the role of these structures in determining serum reactivities remains controversial . In reality, the response of the gonococcus to NHS is probably governed by several parameters involving a number of outer-membrane (OM) components . We surveyed the serum reactivities of 14 strains of N . gonorrhoeae and characterized each of their major OM components . The strains presented a spectrum of sensitivity to pooled NHS . As assessed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis, immunoblotting, and peptide mapping, the strains were also quite heterogeneous in terms of PI, H.8 antigen, and LPS type, and the presence of the 2-1-L8 epitope . Five of the strains had identical PIAs in varying LPS and H.8 backgrounds, and four had identical PIBs in varying LPS and H.8 backgrounds . As assessed by electrophoretic migration and monoclonal antibody binding, Protein III and the 44,000 Dalton protein were identical in these strains . We found no association between PI subclass and serum sensitivity, while H.8 and LPS variation appeared to be related to bactericidal responses . The diversity and close interaction of gonococcal components in the OM are undoubtedly involved in differential abilities to survive NHS killing.

Mol Microbiol, 1990 Aug, 4(8), 1269 - 77
Molecular mechanism for the antigonococcal action of lysosomal cathepsin G; Shafer WM et al.; Human lysosomal cathepsin G (cat G) appears to be an important mediator of non-oxidative killing of Neisseria gonorrhoeae ingested by human polymorphonuclear leucocytes (PMNLs) . Nearly isogenic strains of gonococci having variations in the structure of penicillin-binding protein 2 (PBP2) also exhibit different levels of susceptibility to the lethal action of cat G in vitro . Accordingly, we examined the relationship between gonococcal susceptibility to cat G and PBP2 structure . The results of this study suggest that cat G has the capacity to interact with PBP2, as evidenced by its ability to inhibit binding of {3H}-benzylpenicillin to PBP2 . We also found that changes in the amino acid sequence within the transpeptidase domain of PBP2, because of certain penA mutations, modulated such interactions . We propose that PBP2 is an intracellular target for cat G and that levels of gonococcal susceptibility to cat G may be related to PBP2 structure and/or intracellular availability.

Hautarzt, 1990 Aug, 41(8), 438 - 41
{High-level tetracycline-resistance of Neisseria gonorrhoeae}; Kohl PK et al.; High level tetracycline resistance of Neisseria gonorrhoeae is mediated by a 25.2-MD plasmid and is characterized by a minimal inhibitory concentration of 16 micrograms/ml or more . The 25.2-MD plasmid originated through the insertion of the streptococcal tetM determinant into the 24.5-MD transfer plasmid of N . gonorrhoeae . In the present study the prevalence of N . gonorrhoeae with high-level tetracycline resistance in the Heidelberg gonococcal population between 1981 and 1989 was determined . Among 1765 N . gonorrhoeae isolates, one strain with high-level tetracycline resistance was identified . The presence of the 25.2-MD plasmid in this strain was demonstrated by plasmid-agarose gel electrophoresis . The auxotype/serovar class proline-/IB-1 indicates the importation of this strain from the USA . The 25.2-MD recombinant plasmid, in contrast to the 24.5 MD transfer plasmid, has a rather wide host range, which is favourable to the occurrence both of high-level tetracycline resistance and of beta-lactamase plasmids in N . meningitidis.

Antimicrob Agents Chemother, 1990 Aug, 34(8), 1523 - 8
Genetic diversity of penicillin-binding protein 2 genes of penicillin-resistant strains of Neisseria meningitidis revealed by fingerprinting of amplified DNA; Zhang QY et al.; A 2-kilobase fragment containing the penicillin-binding protein 2 gene (penA) was amplified by using the polymerase chain reaction with DNA prepared from 35 penicillin-resistant strains of Neisseria meningitidis isolated in England, Ireland, and Spain (MICs, 0.16 to 1.28 micrograms of benzylpenicillin per ml) and from 10 penicillin-susceptible strains (MICs, less than or equal to 0.04 micrograms of benzylpenicillin per ml) . The penA genes were digested with HpaII or TaqYI; and the resulting fragments were end-labeled, fractionated on a polyacrylamide gel, and autoradiographed, to produce gene fingerprints . The fingerprints of the penA genes of the 10 penicillin-susceptible strains were identical . In contrast, the fingerprints of the penA genes of all but two of the penicillin-resistant strains differed markedly from those of the penicillin-susceptible strains . The altered penA genes of group B penicillin-resistant strains were very diverse, and 14 different fingerprints were found among the 15 strains that we examined . The penA genes of the 19 resistant group C strains were less diverse, and two major fingerprint patterns predominated.

J Am Osteopath Assoc, 1990 Aug, 90(8), 683 - 5
Effect of culture-medium temperature on growth of Neisseria gonorrhoeae; Cathcart SK et al.; This study was designed to evaluate the effects of culture-medium temperatures on the growth of known quantities of in vitro inoculum of Neisseria gonorrhoeae . Growth of N gonorrhoeae was significantly greater on room-temperature culture medium than on refrigerated culture medium with inocula of 10(2) and 10(3) colony-forming units . There was no difference between growth patterns on room-temperature and those on refrigerated media when inocula were 10(5) and 10(6) colony-forming units.

Scand J Immunol, 1990 Aug, 32(2), 121 - 8
Immunoglobulin V regions of a bactericidal anti-Neisseria meningitidis outer membrane protein monoclonal antibody; Larrick JW et al.; C6 is a potentially therapeutic murine monoclonal antibody that recognizes the class 1 outer membrane protein of Neisseria meningitidis . C6 specifically immunoblots this antigen and augments in vitro killing of N . meningitidis bacteria . We describe a general method of obtaining the heavy and light chain variable-region sequence from immunoglobulin-secreting cells . The method uses mixed polymerase chain reaction (PCR) primers designed from the 5' end of the framework 1 (FR1) sequences of the heavy and light chains, and 3'-end primers for constant-region conserved sequences . The method has been applied to the cloning and sequencing of the variable region of C6 to construct a humanized monoclonal antibody . Rapid amplification and sequencing of variable regions by this general method have multiple applications in the study of the immune response to infectious diseases.

J Infect Dis, 1990 Aug, 162(2), 501 - 5
The role of Neisseria gonorrhoeae and Chlamydia trachomatis in pelvic inflammatory disease and its sequelae in Zimbabwe; De Muylder X et al.; The presence of antibodies to pili of Neisseria gonorrhoeae and Chlamydia trachomatis serovar L2 were assessed in women consecutively hospitalized in Zimbabwe with pelvic inflammatory disease (PID; n = 66), infertility (n = 227), and ectopic pregnancy (n = 60) . Women delivering live full-term infants served as controls . Of the infertile women, 60% had secondary infertility; 59% had macroscopic evidence of a tubal abnormality . Women with PID, infertility and tubal disease, and ectopic pregnancy and tubal disease had significantly higher prevalences of antibodies against C . trachomatis and N . gonorrhoeae than did controls or women with infertility or ectopic pregnancy but no macroscopic tubal abnormalities (P less than .001 for all comparisons) . The prevalence of antibody to chlamydia increased with age (P = .01), unlike the gonococcal antibody . Antibodies to C . trachomatis were associated with a history of PID, being single, a positive Treponema pallidum hemagglutination assay, and chlamydial antibody . None of the controls had human immunodeficiency virus, unlike 3.9%-7.6% of the other women . Tubal abnormalities were implicated in more than half of the cases of infertility.

J Infect Dis, 1990 Aug, 162(2), 506 - 12
Modification by sialic acid of Neisseria gonorrhoeae lipooligosaccharide epitope expression in human urethral exudates: an immunoelectron microscopic analysis; Apicella MA et al.; Expression of lipooligosaccharide (LOS) antigenic determinants during human gonococcal infection was studied in secretions from seven men with gonococcal urethritis . Five monoclonal antibodies with distinct gonococcal LOS specificities and an H.8 lipoprotein monoclonal antibody were used in combination with immunogold electron microscopic analysis . The LOS epitope defined by antibody 6B7 was present on all seven strains in secretions and after in vitro growth . Gonococci from six of seven patients, when grown in vitro, expressed the 6B4 LOS epitope . The 6B4 epitope is a Gal beta 1-4-GlcNAc residue, which is immunochemically similar to the precursor of the human erythrocyte i antigen . This epitope was found unmodified on gonococcal LOS in urethral secretions from two patients . The unmodified epitope could not be demonstrated on organisms in five secretions . Neuraminidase digestion exposed the 6B4 epitope on organisms in these secretions and increased the 6B4 epitope density in the two secretions, which contained the unmodified epitope . These studies indicate that in vivo modification by sialylation of gonococcal LOS Gal beta 1-4-GlcNAc residue occurs during human infection.

Indian J Pediatr, 1990 Jul-Aug, 57(4), 527 - 31
Clinico-bacteriological study of neonatal conjunctivitis; Pandey KK et al.; Perinatal risk factors and bacteriological profile of conjunctivitis were studied among 245 newborns delivered at JIPMER Hospital between July 1986 and June 1988 . Maternal and neonatal factors like lack of antenatal care, presence of adverse intrapartum factors, operative deliveries, birth asphyxia, pre-maturity and prolonged hospital stay significantly increased the chances of developing conjunctivitis (P less than 0.001) . Bacteria were recovered from 163 (66.5%) cases . Staphylococcus was the commonest pathogenic bacteria isolated, followed by Pseudomonas aeruginosa and Klebsiella pneumoniae . Neisseria gonorrhoeae was isolated in only one case . Most of the organisms showed in vitro sensitivity to chloramphenicol, gentamycin and tetracycline . All the cases responded to topical chloramphenicol except three which required systemic antibiotics . No complications were observed . The identification and appropriate management of high risk pregnancies with minimal hospital stay can reduce the incidence of neonatal conjunctivitis.

Pathology, 1990 Jul, 22(3), 157 - 61
An improved screening technique for isolation of Nocardia species from sputum specimens; Ashdown LR; Three selective isolation media and the paraffin baiting technique were compared with conventional culture (Sabouraud dextrose agar without antibiotic supplement) for the ability to grow and detect nocardiae from simulated sputum specimens . Modified Thayer-Martin medium, incorporating vancomycin, colistin, nystatin and trimethoprim as selective agents, produced the highest recovery rate and with the greatest suppression of normal respiratory tract flora . A clinical evaluation using a screening programme devised for a busy diagnostic microbiology laboratory was performed on 1600 sputum specimens . Inoculating sputum on modified Thayer-Martin medium and extending the initial incubation period of 3 days at 35 degrees C under 10% carbon dioxide to a further 3 weeks at room temperature in a candle jar, led to the diagnoses, which otherwise would have been missed, of pulmonary nocardiosis in 3 patients and pulmonary infections due to Neisseria meningitidis, Pseudomonas cepacia, and Serratia marcescens in a further 22 patients.

Rev Infect Dis, 1990 Jul-Aug, 12 Suppl 6, S656 - 64
Pelvic inflammatory disease: review of treatment options; Peterson HB et al.; Decisions regarding appropriate antibiotic therapy for treatment of pelvic inflammatory disease (PID) are complicated by an incomplete understanding of the syndrome . Further, the lack of data on laparoscopic diagnosis and cure of PID severely limits our ability to interpret data on therapy outcome . Validation studies of the treatment regimens recommended by the Centers for Disease Control in the 1985 treatment guidelines for sexually transmitted diseases (STDs) suggest that both the cefoxitin/doxycycline and clindamycin/aminoglycoside combination regimens result in consistently high rates of clinical evidence of cure . The 1989 STD treatment guidelines were based on these studies and on available data regarding newer treatment regimens . Empiric, broad-spectrum therapy remains the treatment of choice . The two regimens recommended for inpatient therapy in 1989 are similar to those recommended in 1985 . The recommendation for management of ambulatory patients has been substantially changed, however, because of increasing resistance of Neisseria gonorrhoeae to penicillin.

J Clin Microbiol, 1990 Jul, 28(7), 1640 - 1
Ophthalmia neonatorum caused by Neisseria cinerea; Bourbeau P et al.; Neisseria cinerea is an organism that has only recently been implicated as a human pathogen . In this case, N . cinerea was identified as the cause of ophthalmia neonatorum (conjunctivitis) in a 2-day-old girl.

Am J Perinatol, 1990 Jul, 7(3), 235 - 8
Microbiology of the lower genital tract and amniotic fluid in asymptomatic preterm patients with intact membranes and moderate to advanced degrees of cervical effacement and dilation; Dunlow SG et al.; The purpose of this prospective investigation was to evaluate the microbiology of the lower genital tract and amniotic fluid in asymptomatic women with preterm labor . We limited inclusion in the study to patients at 20 to 36 weeks' gestation whose membranes were intact and whose cervix was at least 50% effaced and 2 cm dilated . At the time of admission, we obtained an endocervical specimen for culture for Neisseria gonorrhoeae and for enzyme-linked immunoabsorbent assay for Chlamydia trachomatis and a vaginal specimen for culture for group B streptococci (GBS) . We also performed transabdominal amniocentesis to collect amniotic fluid for Gram's stain, latex fixation test for GBS, and aerobic and anaerobic cultures . All patients received parenteral tocolytics . Women who had an immature lecithin to sphingomyelin ratio also received betamethasone . Only 1 of 72 women (1.4%, 95% confidence interval 0 to 4.1%) had a positive amniotic fluid culture . One patient (1.4%) had a positive Gram's stain, and two (2.8%) had positive latex fixation tests . None of these individuals subsequently had a positive culture . Eight women (11.1%) had positive tests for chlamydia, and four (5.5%) had positive vaginal cultures for GBS . None of the patients developed clinical evidence of chorioamnionitis, and only one had puerperal endometritis . None of the neonates had any complications due to infection . We conclude that, in our population, intra-amniotic infection is not a common cause of preterm labor in asymptomatic patients with intact membranes and that amniocentesis should not be performed routinely to assess the bacteriology of the amniotic fluid.

Int J STD AIDS, 1990 Jul, 1(4), 285 - 7
Comparative study of cefuroxime axetil and procaine penicillin in the treatment of uncomplicated gonorrhoea; Kinghorn GR et al.; A total of 311 patients presenting with uncomplicated gonorrhoea were entered into a comparative randomized open-label study and given single-dose treatment with either oral cefuroxime axetil (CAE) or intramuscular procaine penicillin (PP) . Neisseria gonorrhoeae was eliminated from 129 (98%) of 131 evaluable patients treated with CAE and 127 (98%) of 129 evaluable patients treated with PP . None of the 4 treatment failures (3 male and 1 female) were caused by beta-lactamase-producing isolates . Both treatments were well tolerated with minor adverse events reported in 3 (2%) of CAE treated patients . We conclude that CAE is an effective, well tolerated treatment for uncomplicated gonorrhoea which has the convenience and acceptability of single-dose oral therapy.

Microb Pathog, 1990 Jul, 9(1), 19 - 31
Opa (protein II) influences gonococcal organization in colonies, surface appearance, size and attachment to human fallopian tube tissues; Dekker NP et al.; Opa-expressing variants of Neisseria gonorrhoeae strain F62-SF and an Opa- variant, all non-piliated, were examined for differences in the interaction of the bacteria within colonies and in attachment to and damage of human fallopian tube mucosa . Expression of certain Opas was associated with the formation of transparent colonies where the bacteria were tightly packed and evenly spaced within the colonies . Expression of other Opas was associated with the formation of opaque colonies where the gonococci were less tightly packed and were unevenly spaced . Distinct differences in the size of the gonococci and in their surface characteristics were dependent upon the Opa being expressed . Certain Opas were associated with gonococci that had significantly larger cross-sectional areas and bigger perimeters . Scanning electron microscopy showed that OpaC- and OpaD-containing variants yielded greater mucosal damage than OpaB-containing and Opa- variants with the least damage caused by the OpaA-containing variant (clumped bacteria from dark opaque friable colonies) . The mucosal damage after 60 min incubation included shortening and decreased numbers of microvilli on non-ciliated cells and invagination and sloughing of ciliated cells . Differences in the interactions of gonococci within colonies and in attachment to fallopian tube mucosa and damage to the mucosal cells occurred with different Opa-expressing variants of N . gonorrhoeae strain F62-SF.

Hinyokika Kiyo, 1990 Jul, 36(7), 851 - 9
{Epidemiologic and therapeutic study on gonococcal infections--clinical efficacy of cefetamet pivoxil}; Nishimura M et al.; We studied the epidemiology of 109 cases of gonococcal infections (105 males with urethritis and 4 females with cervicitis), together with the basic and clinical effects of cefetamet pivoxil in the cases . The peak of age distribution of the male patients was in the younger half of their twenties, and all of the 4 female cases were between 20 and 39 years old . The major source of infections in the males younger than 25 years old was their girl friends or so-called pick-up friends, and that of the males older than 25 years old workers serving at an amusement center, for example, bars and so-called special massage parlor, which accounted for about three fourths of the male cases between 35 and 44 years old . The distribution of the MIC (inoculum size; 10(6) CFU/ml) of Cefetamet against beta-lactamase non penicillinase producing Neisseria gonorrhoeae (non-PPNG) ranged from 0.025 to 0.1 microgram/ml and that against beta-lactamase producing Neisseria gonorrhoeae ranged from 0.025 to 0.05 microgram/ml . The isolation rate of PPNG was 10.2% (9/88) . In male patients with gonococcal urethritis, the efficacy rate was 100% on days 3 and 7 for 1,000 mg single dose and 7-day treatment and 500 mg single dose treatment . One of the cases treated with 250 mg single dose therapy was unchanged at 3, but the efficacy rate of the remaining cases was 100% at day 7 . Complicated urethritis with C . trachomatis was noticed in 25.7% (5/105) of the male urethritis and in 25.0% (1/4) of the female cervicitis cases . The only side effect was diarrhea observed in 1 of the 124 case (0.8%).

Kansenshogaku Zasshi, 1990 Jul, 64(7), 822 - 9
{A clinical study on five cases of respiratory infections caused by Neisseria meningitidis}; Yagyu Y et al.; Five cases of the respiratory infections, in which Neisseria meningitidis was isolated upon the examination of the transtracheal aspiration (TTA), were reported . Patients studied were four males at the ages of 18, 56, 66 and 78 years, and a 18-year old female . Five cases were bronchopneumonia (two cases), acute bronchitis (two cases) and diffuse panbronchiolitis (DPB) (one case) . Underlying diseases were as follows: lung cancer or acute myocardial infarction in cases of bronchopneumonia, and interstitial pneumonia or pulmonary tuberculosis in cases of acute bronchitis . There was a case in which only N . meningitidis was cultured from specimens obtained by TTA, although another different organism, in addition to N . meningitidis, was recovered from the patient of other cases . Other organisms found together with N . miningitidis were H . influenzae (2 cases), S . dysgalactiae (1 case) and M . tuberculosis (1 case) . Predisposing factors were common cold in the female patient and bronchoscopic examination in the cases of lung cancer and of interstitial pneumonia . Two of the five cases occurred consecutively in the same room and so they were considered as nosocomial infections . With these findings, it can be posturated that N . meningitidis might be one of the etiological agents of the respiratory infections.

FEMS Microbiol Lett, 1990 Jul, 58(2), 145 - 50
Iron and outer membrane proteins in the susceptibility of Neisseria meningitidis to human serum; Criado MT et al.; The proportion of carrier-isolated Neisseria meningitidis strains sensitive to human serum (37.2%) was found to be significantly higher than that of case-isolated ones (4.1%), although the difference is too low to consider serum-resistance responsible for invasion in this microorganism . Serum-susceptibility was not related to the existence of specific outer membrane proteins, as is the case of N . gonorrhoeae . Iron restriction induced iron-regulated outer membrane proteins in each strain (but not the same proteins in all strains) but without any detectable effect on serum-susceptibility . Iron excess was also unable to induce changes in the susceptibility of N . meningitidis to human serum.

Rev Infect Dis, 1990 Jul-Aug, 12 Suppl 6, S633 - 44
Therapy for gonococcal infections: options in 1989; Moran JS et al.; The choice of therapy for Neisseria gonorrhoeae infections is complicated by antibiotic resistance and by the varying efficacy of some antibiotics at different anatomic sites of infection . Ceftriaxone (a single intramuscular dose of 250 mg) is a simple, effective, and generally well-tolerated choice for uncomplicated N . gonorrhoeae infection at all anatomic sites . Alternatives include single-dose oral regimens of ciprofloxacin, norfloxacin, and cefuroxime axetil as well as single-dose intramuscular regimens of spectinomycin, ceftizoxime, and cefotaxime . The addition of doxycycline (100 mg orally twice a day for 7 days) is recommended for presumptive treatment of chlamydial coinfection . Tetracyclines should not be used as sole therapy for gonococcal infection because of gonococcal resistance.

J Gen Intern Med, 1990 Jul-Aug, 5(4), 319 - 26
A new diagnostic index for predicting cervical infection with either Chlamydia trachomatis or Neisseria gonorrhoeae; Rosenthal GE et al.; OBJECTIVE: To develop and test a diagnostic index for estimating the probability of cervical infection with either Chlamydia trachomatis or Neisseria gonorrhoeae . DESIGN: Prospective, cross-sectional study in two phases: 1) to develop a diagnostic index based on independent predictors of cervical infection; 2) to test the index . SETTINGS: A hospital-based clinic and a student health service . PATIENTS: Development phase: 190 nonpregnant women seen in the gynecology clinic; testing phase: 588 women seen in the gynecology clinic (n = 372) or the student health service (n = 216) . INTERVENTIONS: Experienced clinicians recorded historical, physical, and microscopic findings on standard forms and tested women for chlamydial and gonococcal infections . RESULTS: Three independent predictors of cervical infection were identified and weighted: age (two points if less than 20 years and one point if 20-29 years); a new sex partner or one suspected of having a genital infection (one point); purulent vaginal discharge (one point) . In the testing groups, cervical infection was present in none of 62 women with no points, seven of 269 (3%) with one point, 14 of 188 (7%) with two points, and 19 of 69 (28%) with three or four points (p less than 0.001) . The index estimated the probability of infection more accurately (p less than 0.01) than did clinicians, performed well in each site, and remained accurate when C . trachomatis and N . gonorrhoeae were considered separately . CONCLUSION: The diagnostic index accurately estimates the probability of cervical infection with either C . trachomatis or N . gonorrhoeae and may be useful in selecting women for definitive diagnostic testing.

S Afr Med J, 1990 Jun 16, 77(12), 647 - 8
Child sexual abuse and gonococcal conjunctivitis . A case report; O'Farrell N et al.; An unusual presentation of child sexual abuse is reported . A 6-year-old girl developed a unilateral purulent conjunctival discharge . Neisseria gonorrhoeae was isolated from conjunctival and genital swabs . Genital examination and further enquiries by social workers confirmed a diagnosis of sexual abuse.

S Afr Med J, 1990 Jun 16, 77(12), 626 - 8
Sexually transmitted pathogens and colposcopic findings in asymptomatic HIV-1 antibody-positive blood donors; Hoosen AA et al.; Sixteen asymptomatic human immunodeficiency virus (HIV-1) antibody-positive female blood donors were examined for sexually transmitted diseases by lower genital tract microbiological tests and colposcopy . Two donors had generalised lymphadenopathy, and in 13 (81.2%) human papillomavirus was detected on histological examination . In 5 (31.2%) Neisseria gonorrhoeae was cultured . Sexually transmitted pathogens were found in all but 3 subjects and multiple agents were detected in 9 . The high prevalence of sexually transmitted diseases coupled with the generally poor response to counselling has a frightening potential for spread of HIV locally.

Pediatr Infect Dis J, 1990 Jun, 9(6), 385 - 9
Outpatient management of selected infants younger than two months of age evaluated for possible sepsis; McCarthy CA et al.; Previously healthy infants younger than 2 months of age without evidence of soft tissue or musculoskeletal infection who had white blood cell counts between 5000 and 15,000/mm3, band form counts less than or equal to 1500/mm3, urinalysis less than or equal to 10 white blood cells/high power field (spun sediment) and stool less than or equal to 5 white blood cells/high power field (if diarrhea) were considered at low risk for a serious bacterial infection . Infants meeting these criteria whose parents were judged to be adequate observers and had a telephone and automobile were eligible for outpatient management . Infants were given ceftriaxone to cover the possibility that the low risk criteria might miss more infants with serious bacterial infections than was predicted . From Jan . 1, 1987 to May 31, 1989, 86 infants younger than 2 months were enrolled . There were no serious complications in these infants . Twelve had transient problems possibly related to the intramuscular ceftriaxone therapy . One low risk infant was hospitalized for Neisseria meningitidis bacteremia and five other infants were hospitalized for medical or social reasons . All six hospitalized infants had short admissions and did well . This study supports the continued use of the low risk criteria to distinguish infants unlikely to have a serious bacterial infection . Furthermore, in a selected group of low risk infants, outpatient management may be an acceptable alternative to inpatient therapy.

Br J Clin Pract, 1990 Jun, 44(6), 216 - 8
Efficacy of ceftizoxime in the treatment of uncomplicated gonorrhoea: comparison with amoxycillin; Veeravahu M et al.; Four centres contributed a total of 466 patients to a study comparing the efficacy of oral amoxycillin with that of probenecid and intramuscular ceftizoxime . Both treatments were equally efficacious, except in the small number of penicillinase-producing Neisseria gonorrhoeae patients, all of whom responded to ceftizoxime and none to amoxycyllin . Both treatments were well tolerated, the only two adverse effects occurring in the ceftizoxime group.

EMBO J, 1990 Jun, 9(6), 1991 - 9
Extracellular transport of cholera toxin B subunit using Neisseria IgA protease beta-domain: conformation-dependent outer membrane translocation; Klauser T et al.; The beta-domain of the Neisseria IgA protease precursor (Iga) provides the essential transport function for the protease across the outer membrane . To investigate the secretion function of the beta-domain (Iga beta), we engineered hybrid proteins between Iga beta and the non-toxic 12 kd cholera toxin B subunit (CtxB) and examined their targeting behaviour in Salmonella typhimurium . We show that CtxB-Iga beta hybrid proteins integrate into the outer membrane, leading to the exposition of the CtxB moiety on the cell surface . Exposed CtxB can be degraded by externally added proteases like trypsin, but can also be specifically cleaved off from membrane-associated Iga beta by purified IgA protease . We further demonstrate that folding of the CtxB moiety at the periplasmic side of the outer membrane interferes with its translocation . Prevention of disulphide-induced folding in periplasmic CtxB renders the protein moiety competent for outer membrane transport . Iga beta may be of general interest as an export vehicle for even larger proteins from Gram-negative bacteria.

Infect Immun, 1990 Jun, 58(6), 2008 - 10
Two distinct outer membrane serotype subcomplexes of Neisseria meningitidis serogroup A; Blasius R et al.; A 350-kilodalton serotype outer membrane complex containing the class 1, 3, and 4 outer membrane proteins was isolated from serogroup A Neisseria meningitidis . Partial denaturation yielded two serotype subcomplexes containing the class 3 and 1 proteins (85 kilodaltons) and the class 3 and 4 proteins (94 kilodaltons), respectively.

Ann Soc Belg Med Trop, 1990 Jun, 70(2), 99 - 103
{Neisseria gonorrhoea in Pikine (Senegal): survey of antibiotic sensitivity}; Van de Velden L et al.; The antimicrobial sensitivity of 96 strains of Neisseria gonorrhoeae, isolated in 1987-88 in Pikine, Senegal was determined . Twenty four percent of isolates produced beta-lactamase (PPNG) . Among the beta-lactamase negative strains, 27% showed a decreased sensitivity to penicillin (MIC 0.125-0.25 mg/l) and 3% were resistant (MIC greater than or equal to 0.5 mg/l) . Seventeen percent of isolates showed a decreased sensitivity to thiamphenicol (MIC 1-4 mg/l) and 7% were moderately resistant to tetracycline (MIC 2-4 mg/l) . All isolates were sensitive to spectinomycin and sensitive to moderately sensitive to kanamycin . During an earlier survey performed in 1981, chromosomal resistance to tetracycline was not seen and only 4% of strains were beta-lactamase positive . These results suggest a decreasing antimicrobial sensitivity of N . gonorrhoeae in Pikine . Spectinomycin can be used as a first choice antimicrobial and thiamphenicol may be recommended as a valuable alternative treatment of gonorrhoea in Pikine, Senegal.

Gifu Shika Gakkai Zasshi, 1990 Jun, 17(1), 131 - 51
{Studies on plaque formed on implants}; Nakazato G; In vivo plaque formation on implant materials was studied . When different implant materials were set on the gingiva, the number of adhering viable bacteria depended on material surface properties 4 hours after setting, but not 48 hours after setting . The formation of pellicle-like thin layers and subsequent covering by lamellarly formed plaque were observed on the surfaces of all materials . Streptococcus species were predominant at the 4-hour setting time but anaerobes increased at the 48-hour setting time; this was common to all materials . The results indicate that surface properties of the implants influence early bacterial adherence, but do not influence bacterial flora or plaque maturation . The subgingival microflora at the neck of implants with clinically normal peri-implant tissues was compared with that at the neck of natural teeth . The bacterial isolates were classified based on their biochemical characteristics . For the spirochaetes, the number was counted directly under light microscopic observation . The most predominant bacterial species was Streptococcus, followed by Actinomyces, Neisseria and then Capnocytophaga at both sites . The ratio of spirochaetes in the microflora was extremely low for both the implant and natural tooth . Such a bacterial distribution pattern closely resembled the hitherto-reported distribution of bacteria existing in a healthy gingival crevicular . This suggested that the microflora in plaque at the neck of a normal implant is basically similar to that at the neck of a natural tooth . In conclusion, plaque formation on implant materials was not influenced by their surface properties in actual oral cavity.

Mol Microbiol, 1990 Jun, 4(6), 913 - 9
Insertion of an extra amino acid is the main cause of the low affinity of penicillin-binding protein 2 in penicillin-resistant strains of Neisseria gonorrhoeae; Brannigan JA et al.; Non-beta-lactamase-producing, penicillin-resistant strains of Neisseria gonorrhoeae (CMRNG strains) produce altered forms of penicillin-binding protein 2 (PBP2) that have decreased affinity for penicillin . A feature of PBP2 from all CMRNG strains is the presence of an additional residue (Asp-345A) that is absent from PBP2 of penicillin-sensitive strains . The role of the additional aspartic acid residue in the decreased affinity of PBP2 is unclear as PBP2 of all previously examined CMRNG strains possess several other amino acid sequence alterations, in addition to the insertion of Asp-345A, compared to PBP2 of penicillin-sensitive strains . Site-directed mutagenesis has been used to insert the Asp-345A codon into the penA gene from a penicillin-sensitive gonococcus . The resulting penA gene expressed an altered form of PBP2 that had a decreased affinity for benzylpenicillin and was able to transform a penicillin-sensitive strain of N . gonorrhoeae to an increased level of resistance to benzylpenicillin . Insertion of amino acids other than aspartic acid did not produce forms of PBP2 that provided increased resistance to penicillin . Removal of the Asp-345A codon from the penA gene of a CMRNG strain reduced its ability to transform a penicillin-sensitive strain to an increased level of penicillin resistance . The reduction in the affinity of PBP2 in CMRNG strains is therefore largely, although not exclusively, due to the insertion of Asp-345A . Clinical isolates that produce altered forms of PBP2 that differ from that of penicillin-sensitive strains only in the insertion of Asp-345A have been identified.

Arzneimittelforschung, 1990 Jun, 40(6), 684 - 5
In vitro activities of seven quinolone derivatives against Neisseria gonorrhoeae; van der Willigen AH et al.; The in vitro activities of ciprofloxacin, enoxacin, fleroxacin, lomefloxacin, norfloxacin, ofloxacin, and pefloxacin against 10 penicillinase-producing N . gonorrhoeae strains (PPNG's), 10 non-PPNG's, 10 non-penicillinase-producing penicillin-resistant chromosomally mediated N . gonorrhoeae strains (CMRNG's) 3 N . gonorrhoeae strains with a decreased sensitivity against quinolones compounds and one tetracycline-resistant penicillinase-producing N . gonorrhoeae (TRNG/PPNG), strain were evaluated in this study . The non PPNG, PPNG, CMRNG and TRNG/PPNG strains showed good to excellent sensitivity to the quinolones tested . The N . gonorrhoeae strains with a decreased sensitivity against quinolones showed higher MIC (minimum inhibitory concentration) values.

Antimicrob Agents Chemother, 1990 Jun, 34(6), 971 - 3
In vitro activity of tosufloxacin (A-61827; T-3262) against selected genital pathogens; Segreti J et al.; The in vitro activity of tosufloxacin (A-61827; T-3262) against 15 clinical isolates of Chlamydia trachomatis and 31 recent clinical isolates of Neisseria gonorrhoeae, including 15 spectinomycin-resistant N . gonorrhoeae and 16 penicillinase-producing N . gonorrhoeae, was determined . Tosufloxacin was compared with doxycycline, ciprofloxacin, and temafloxacin against C . trachomatis . Susceptibility testing was performed by using McCoy cell monolayers . The in vitro activity of tosufloxacin against N . gonorrhoeae was compared with that of ciprofloxacin, temafloxacin, doxycycline, ceftriaxone, and spectinomycin by using an agar dilution method . Tosufloxacin was as active as temafloxacin against C . trachomatis (MIC for 90% of strains tested {MIC90}, 0.25 microgram/ml; MBC for 90% of strains tested {MBC90}, 0.25 microgram/ml) and was almost as active as doxycycline (MIC90, 0.06 microgram/ml; MBC90, 0.125 microgram/ml) . Ciprofloxacin, temafloxacin, and tosufloxacin were extremely active against N . gonorrhoeae, including spectinomycin-resistant N . gonorrhoeae and penicillinase-producing N . gonorrhoeae, with MIC90s of 0.004, 0.015, and 0.008 microgram/ml, respectively . Ceftriaxone was slightly less active (MIC90, 0.03 microgram/ml), and doxycycline was the least active drug tested (MIC90, 4.0 micrograms/ml) . Tosufloxacin and temafloxacin had excellent activity against the C . trachomatis and N . gonorrhoeae strains tested.

Vaccine, 1990 Jun, 8(3), 225 - 30
Vaccination against gonorrhoea: the potential protective effect of immunization with a synthetic peptide containing a conserved epitope of gonococcal outer membrane protein IB; Heckels JE et al.; Monoclonal antibody SM24 recognizes a protective, highly conserved but non-immunogenic epitope on outer membrane protein PIB of Neisseria gonorrhoeae . A series of overlapping synthetic peptides, spanning the deduced amino acid sequence of PIB from strain R10, have been synthesized on solid phase supports . Monoclonal antibody SM24 reacted with two adjacent decapeptides corresponding to residues 191-200 and 196-205, containing the common sequence TYSIP . Following localization of the epitope recognized, a peptide was synthesized corresponding to residues 193-204 . The peptide was coupled to a carrier protein (KLH) and both the free peptide and peptide-KLH conjugate were used for immunization of rabbits . The resulting antisera reacted with the immunizing peptide, with denatured PIB on Western blots and, in addition, with native PIB in outer membranes of both the homologous and a heterologous strain . In the presence of human complement the sera were bactericidal for both the homologous and the heterologous strain . Thus synthetic peptides may be used to induce a protective polyclonal immune response against epitopes on gonococcal PI which are normally only weakly or non-immunogenic.

Am J Med, 1990 May 14, 88(5A), 15S - 19S
Spectrum of disease due to Branhamella catarrhalis in children with particular reference to acute otitis media; Marchant CD; For many years Branhamella catarrhalis was regarded as a non-pathogenic inhabitant of the respiratory tract . This article outlines the spectrum of B . catarrhalis disease in childhood and the extent of the evidence for a pathogenic role of the organism . B . catarrhalis is a rare etiologic agent in septicemia, meningitis, and other systemic illness in both apparently normal and immunocompromised infants and children . It is an unusual cause of ophthalmia neonatorum, but can be confused with Neisseria gonorrhoeae . Whether or not B . catarrhalis is acquired from the birth canal in these cases has not been established . B . catarrhalis is most common as a respiratory tract pathogen in children, including pneumonia, bacterial tracheitis, sinusitis, and otitis media . Since it is difficult to rigorously document pathogenicity of any bacterium in bronchopulmonary infections in children, it is probable that the spectrum of B . catarrhalis disease is wider than that reported to date . The evidence for pathogenicity in acute otitis media is more extensive than for other infections . Otitis media due to B . catarrhalis is clinically similar to that due to other pathogens . B . catarrhalis can be isolated in pure culture from the middle ear exudate and persists if there is no antibacterial treatment . Gram-negative intracellular and extracellular diplococci can be seen on smears of the inflammatory exudate . There is preliminary evidence that there is an antibody response in B . catarrhalis otitis media . B . catarrhalis has emerged as an important and common pathogen in neonates, infants, and children.

Biochim Biophys Acta, 1990 May 9, 1024(1), 185 - 8
Transfer of human membrane surface components by incorporating human cells into intact animal tissue by cell-tissue electrofusion in vivo; Heller R et al.; Current animal models employed for the study of the obligate human pathogen Neisseria gonorrhoeae fail to utilize specific human gonococcal attachment receptors required to initiate pathogenesis in a clinically meaningful way . This communication presents evidence that suggests that cell-tissue electrofusion may be employed to create an animal model for this human specific pathogen . This new biotechnology was used to incorporate human membrane gonococcal receptors directly into epithelium of laboratory animals and subsequently infecting the histologically modified tissue with N . gonorrhoeae strain Pgh 3-2.

J Immunol Methods, 1990 May 8, 129(1), 15 - 22
Comparison of two serum bactericidal assays for Neisseria gonorrhoeae; Pettit RK et al.; Pooled normal human serum killing of 14 strains of Neisseria gonorrhoeae was assessed by dilution plate and microtiter methods . In both assays, the strains presented a spectrum of sensitivity to the serum . In the dilution plate assay, results with two different concentrations of human serum were similar for most, but not all of the strains tested . When data for all of the strains were compared, no correlation was found between the dilution plate and microtiter bactericidal assays . Finally, we found that the bactericidal capacities of intact and complement-depleted human sera were very similar when assessed by microtiter methods, suggesting a non-complement-mediated serum killing mechanism.

J Biol Chem, 1990 May 5, 265(13), 7243 - 7
Structure of the L5 lipopolysaccharide core oligosaccharides of Neisseria meningitidis; Michon F et al.; Three different oligosaccharides were isolated by mild acid hydrolysis of the lipopolysaccharides, obtained from Neisseria meningitidis serotype 5, and their structures were elucidated by combined chemical and physical techniques . The use of 500-MHz 1H NMR in both one-dimensional and two-dimensional modes as well as nuclear Overhauser effect experiments were employed . To assist in the structural assignments the purified oligosaccharides were also degraded by chemical and enzymatic procedures to smaller fragments . The largest of the three original oligosaccharides is a triantennary partially O-acetylated decasaccharide in which the largest antenna terminates in a lacto-N-neotetraose unit . The smaller oligosaccharides (heptasaccharide and octasaccharide) except for terminal glycose deletions from the longest antenna are structural replicas of the larger.

Hinyokika Kiyo, 1990 May, 36(5), 569 - 75
{Detection of beta-lactamase-producing strains isolated from urinary tract and their drug susceptibility}; Fukatsu H et al.; A total of 518 bacterial strains isolated from the urine of patients with various urological diseases in our Urological Department between November, 1987 and February, 1989 were studied for their beta-lactamase production and susceptibility to various antimicrobial agents was determined . beta-lactamase activity was determined by the acidometry disc method . There were 241 gram-positive cocci, 276 of gram-negative rods and 1 Neisseria gonorrhoeae . Thirty-four percent of the gram positive and 76.3% of gram negative rods produced beta-lactamase . S . aureus (81.3%), S . epidermidis (65.1%) in gram-positive cocci, E . cloacae (100%), S . marcescens (100%), C . freundii (100%), P . aeruginosa (97.2%), P . Rettgeri (88.9%), E . gergoviae (85.7%), K . oxytoca (84.6%), M . morganii (81.8%) and E . coli (69.0%) in gram-negative rods produced beta-lactamase at a higher rate . beta-lactamase produced by gram-positive cocci was entirely penicillinase, and that produced by gram-negative rods only penicillinase in 4.0%, only cephalosporinase in 44.2% and both in 25.4% . In S . aureus and S . epidermidis, the isolated rate of strains resistant to ampicillin (p less than 0.01) and piperacillin (p less than 0.05) in the beta-lactamase producing strains was significantly higher than that in the beta-lactamase non-producing strains . In E . coli, the isolation rate of strains resistant to ampicillin and piperacillin in the penicillinase-producing strains was significantly higher than in the penicillinase non-producing strains (p less than 0.01) . But both cephalosporinase-producing strains and beta-lactamase non-producing strains showed high susceptibility to cephalothin . These results suggest that the penicillinase might present a clinical problem in the treatment of urinary tract infections by S . aureus, S . epidermidis and E . coli.

J Adolesc Health Care, 1990 May, 11(3), 223 - 6
Survey of genitourinary organisms in a population of sexually active adolescent males admitted to a chemical dependency unit; Jenkins SC et al.; Sixty-two males consecutively admitted to an adolescent chemical dependency unit for treatment over a one-year period were studied . When interviewed, all denied having urogenital symptoms . Forty-eight reported having had sexual intercourse . Of these 48, 34 were screened (urethral swab) for Neisseria gonorrhoeae, Chylamydia trachomatis, Ureaplasma urealyticum, and Gardnerella vaginalis . Eighteen of the 34 males who had complete screening were found to harbor one or more organisms: 3 had Chlamydia, 13 had Ureaplasma, and 11 had Gardnerella . In addition, 61 of the original 62 subjects were tested for serum antibodies to Treponema pallidum and for pyuria . No subjects were found to have syphilis . Pyuria was present in all subjects with Chlamydia but in only two with Ureaplasma or Gardnerella.

Obstet Gynecol, 1990 May, 75(5), 867 - 72
A randomized comparison of gentamicin-clindamycin and cefoxitin-doxycycline in the treatment of acute pelvic inflammatory disease; Walters MD et al.; In this prospective trial, 130 hospitalized patients with acute pelvic inflammatory disease based on clinical criteria were randomly treated with intravenous gentamicin plus clindamycin (N = 63) or cefoxitin plus doxycycline (N = 67) for at least 4 days, followed by oral clindamycin or doxycycline, respectively, for a total of 14 days . Pre-treatment cultures were obtained for endocervical Neisseria gonorrhoeae and Chlamydia trachomatis, and for endometrial C trachomatis and aerobic and anaerobic bacteria . Overall, 46 subjects (35%) had endocervical cultures positive for N gonorrhoeae . Endocervical and endometrial cultures were positive for C trachomatis in 16 and 6%, respectively . Ninety-five percent of patients had at least one aerobic bacterium, 38% had at least one anaerobic bacterium, and only 2% had no organisms isolated from their endometrium . Fifty-seven subjects taking gentamicin-clindamycin (90.5%) and 64 subjects taking cefoxitin-doxycycline (95.5%) were clinically cured, a nonsignificant difference . Three subjects treated with gentamicin-clindamycin and one treated with cefoxitin-doxycycline required hysterectomy or salpingectomy for cure . Follow-up examinations and cultures were performed in 84% of the subjects . Post-treatment cultures for N gonorrhoeae were negative in all cases tested . Post-treatment endocervical and endometrial C trachomatis cultures were negative in ten of 11 subjects treated with gentamicin-clindamycin and in eight of nine treated with cefoxitin-doxycycline, a nonsignificant difference . We conclude that gentamicin-clindamycin and cefoxitin-doxycycline have similar clinical cure rates for acute pelvic inflammatory disease and are equivalent in eradicating genital N gonorrhoeae and C trachomatis.

Acta Odontol Venez, 1990 May-Dec, 28(2-3), 9 - 13
{Microbiological composition of dental plaque using Sprague Dawley rats as an experimental model}; Sanchez FR et al.; In this study, the microbiological composition of the dental plaque in 12 male Sprague-Dawley rats was determined . Analysis using the light microscope showed the presence of nine colonies which suggested the presence of cocci, (6) diplococci (1) and rods . (2) Five of the bacteria were Gram positive and three were Gram negative . The morphological characteristic suggested the presence of Actinomyces in the case of Gram positive rods; Fusobacterium in the case of Gram negative rods; Neisseria and Veillonella in the of Gram negative cocci and Streptococci for the rest of the colonies . The biochemical characterization of the bacteria suggested the absence of Streptococcus mutans in the dental plaque of this animals.

Diagn Microbiol Infect Dis, 1990 May-Jun, 13(3), 265 - 7
Evaluation of five rapid systems for the identification of Neisseria gonorrhoeae; Dolter J et al.; Five commercial kit systems for the rapid identification of Neisseria gonorrhoeae were evaluated . The systems were tested with various pathogenic and saprophytic Neisseria and Branhamella strains having reactions typical for their individual species . Three systems (RIM-N, quadFERM, and RapID NH) were found to be 100% sensitive and specific.

Diagn Microbiol Infect Dis, 1990 May-Jun, 13(3), 217 - 21
Use of the Gen-Probe PACE system for the detection of Neisseria gonorrhoeae in urogenital samples; Granato PA et al.; The Gen-Probe PACE (Probe Assay-Chemiluminescent Enhanced) system for Neisseria gonorrhoeae was compared to Martin-Lewis medium in JEMBEC plates for the direct detection of N . gonorrhoeae in urogenital samples . This 2-hr, nonisotopic chemiluminescent test is based on the use of an acridinium ester-labeled DNA probe that binds with gonococcal target rRNA in a clinical sample . Following the separation of the hybridized probe from the unhybridized probe through the use of magnetic microparticles, the acridinium ester is hydrolyzed from the hybridized probe by the addition of an alkaline hydrogen peroxide solution, resulting in the production of light, which is measured in a luminometer . The amount of light generated is directly proportional to the amount of gonococcal target rRNA present in the sample . A total of 209 urethral and 203 endocervical specimens were collected from a high-risk, clinic population with a gonococcal disease prevalence of 24% during the study period . Statistical analyses of the overall results showed that, compared to culture, the Gen-Probe PACE System had a sensitivity, specificity, and positive and negative predictive values of 90%, 99%, 98%, and 97%, respectively . The comparative results of this study showed that the Gen-Probe PACE System for N . gonorrhoeae is a reasonable, noncultural alternative for detecting gonococci directly in urogenital specimens.

Diagn Microbiol Infect Dis, 1990 May-Jun, 13(3), 205 - 8
Rapid identification of Branhamella catarrhalis . A comparison of five rapid methods; Louie M et al.; Five methods for the rapid identification and differentiation of Branhamella catarrhalis from other Neisseria species in 86 respiratory specimens were compared . These tests included the 4-methylumbelliferyl butyrate (MUB), API quadFerm, B.CAT.Confirm, Gonochek II, and the Tributyrin disc . All five tests reliably and accurately identified 31 B . catarrhalis isolates . However, the MUB test was the least expensive, least labor intensive, and did not require overnight purity plates for performance . The MUB test provided same-day identification of B . catarrhalis isolates from the initial primary isolation culture.

FEMS Microbiol Lett, 1990 May, 57(1-2), 37 - 42
The 70 kilodalton iron regulated protein of Neisseria meningitidis is not the human transferrin receptor; Ala'Aldeen DA et al.; Neisseria meningitidis is able to chelate iron from human transferrin (HTF), the main sequestrator of extracellular iron in vivo . Previous workers have reported that a ca . 70 kilodalton (kDa) iron regulated outer membrane protein (FeRP-70) is a highly specific receptor for HTF . We have examined the interaction between the iron regulated outer membrane proteins (OMP's) and HTF, using HTF and rabbit anti HTF, as well as gold labelled HTF (Au-HTF) to blot OMP's of various serogroups and serotypes of N . meningitidis . Also, we used monospecific rabbit anti FeRP-70 in competitive experiments to determine the role of FeRP-70 in HTF-binding . Single proteins (molecular weights range ca . 60 to ca . 90 kDa) were identified in the OMP's from each strain which reacted with HTF . HTF failed to block the reaction between FeRP-70 and the OMP's, conversely anti FeRP-70 failed to block the HTF-binding reaction . We believe that the 70 kDa iron regulated protein of N . meningitidis is not a human transferrin receptor.

FEMS Microbiol Lett, 1990 May, 57(1-2), 31 - 6
Antigenic and molecular heterogeneity of the transferrin-binding protein of Neisseria meningitidis; Griffiths E et al.; The transferrin-binding protein in 35 Neisseria meningitidis isolates was examined using a binding assay involving 125I-transferrin . The results show that most strains have a binding protein with a Mr between 78 kDa and 83 kDa; only 4 strains had a binding protein with a Mr of about 68 kDa . The side of the protein appears unrelated to the serogroup or serotype of the organism . Using antibodies raised to whole cells of N . meningitidis grown under iron restriction we show also that considerable antigenic heterogeneity exists amongst the transferrin-binding proteins . This makes it a less than promising vaccine candidate antigen, although conserved antigenic domains are now being sought.

Infection, 1990 May-Jun, 18(3), 181 - 5
Physiological effect of the alterations of plasmids derived from Neisseria gonorrhoeae; Domenico P et al.; Transfer of plasmid DNA from penicillinase-producing Neisseria gonorrhoeae to Escherichia coli produced relatively small colonies that became pigmented in the presence of the dye, congo red . Mutations to large, non-pigmented colonies were frequent, and were the result of a variety of alterations in these plasmids . Miniplasmid formation was the major alteration that led to non-pigmented colonies . However, deletions in any of three putative replication regions resulted in non-pigmented colonies . These altered plasmids mediated significantly less beta-lactamase production than that of the parent plasmid . A new origin of replication was discovered and mapped within the miniplasmid . This origin was responsible for: 1) high plasmid copy number, 2) stability of inheritance, and 3) the majority of beta-lactamase produced in culture . The evolution of gonococcal plasmids may be followed in E . coli, since less defective plasmids produce nonpigmented colonies on congo red agar medium.

Antimicrob Agents Chemother, 1990 May, 34(5), 819 - 22
Oral ciprofloxacin versus ceftriaxone for the treatment of urethritis from resistant Neisseria gonorrhoeae in Zambia; Bryan JP et al.; Neisseria gonorrhoeae strains resistant to treatment with penicillin, tetracycline, and/or spectinomycin are increasing in prevalence in many parts of the world . In Zambia, 52% of N . gonorrhoeae isolates produced beta-lactamase in 1986 . Few oral regimens have proven effective for treatment of resistant N . gonorrhoeae . We conducted a prospective, double-blind, randomized clinical trial of 250 mg of ciprofloxacin given orally versus 250 mg of ceftriaxone given intramuscularly for treatment of uncomplicated gonococcal urethritis in adult males . Two hundred men were enrolled and treated . The two groups were comparable in age (27.5 years), prevalence of latent syphilis (14 and 10%), and human immunodeficiency virus infection (32 and 38%) . Of 165 patients with cultures positive for N . gonorrhoeae who returned for follow-up, ciprofloxacin cured 83 of 83 (100%), including 26 with penicillinase-producing N . gonorrhoeae (PPNG) and 21 with N . gonorrhoeae with chromosomally mediated resistance to multiple antibiotics (CMRNG), and ceftriaxone cured 81 of 82 (98.7%), including 30 with PPNG and 19 with CMRNG . Both treatment regimens were well tolerated . Chlamydia trachomatis in urethral exudate was found by direct fluorescent-antibody microscopic examination or by culture in 10 (5%) participants . All N . gonorrhoeae isolates were inhibited by ceftriaxone at 0.06 micrograms/ml, except one which was inhibited at 0.125 micrograms/ml, while ciprofloxacin inhibited all isolates at 0.03 micrograms/ml . Ciprofloxacin is a safe and effective therapy for uncomplicated gonococcal urethritis, including that caused by PPNG and CMRNG in human immunodeficiency virus-infected men.

J Med Microbiol, 1990 May, 32(1), 1 - 7
Expression of carbonic anhydrase in neisseriae and other heterotrophic bacteria; Nafi BM et al.; A diverse range of heterotrophic bacteria was screened for the presence of carbonic anhydrase (CA) activity, sensitivity to inhibition of growth by acetazolamide (CA inhibitor), and the presence of protein binding monospecific antibody prepared against purified Neisseria sicca CA . CA activity was demonstrated only in strains of N . sicca and N . gonorrhoeae . However, all Neisseria strains, including various isolates of N . meningitidis and N . lactamica, were sensitive to acetazolamide, when grown in air, and showed serological cross-reaction with N . sicca CA . Strains of other genera were resistant to acetazolamide . A number of strains including members of the genera Pseudomonas, Staphylococcus, Streptococcus, Serratia and Proteus also strongly expressed a gene product(s) immunologically related to CA . The presence of CA cross-reacting proteins, which lack hydrase activity, is discussed in relation to the function of the various mammalian CA isoenzymes.

FASEB J, 1990 May, 4(8), 2518 - 27
Antibody production in vitamin A-depleted rats is impaired after immunization with bacterial polysaccharide or protein antigens; Pasatiempo AM et al.; Vitamin A nutritional status has been implicated as important in maintaining the integrity of immune functions . We have determined the effect of vitamin A (retinol) depletion on the ability of young animals to produce antibodies after challenge with various bacterial antigens . Male Lewis rats raised on vitamin A-free or adequate diets were immunized either near 40 days of age, before signs of vitamin A deficiency were apparent, or near 47 days of age when symptoms of deficiency were beginning to be manifest . For rats immunized with polysaccharide antigens from Streptococcus pneumoniae or Neisseria meningitidis, antibody production did not exceed 0-19% of the response of control rats . Vitamin A depletion also severely compromised the response to two T cell-dependent antigens, tetanus toxoid and sheep red blood cells . In striking contrast, retinol-depleted rats immunized with lipopolysaccharides from Pseudomonas aeruginosa and Serratia marcesens produced an antibody response indistinguishable from retinol-sufficient animals . These lipopolysaccharides could elicit antibodies in rat pups, whereas the capsular polysaccharide antigens could not . This is consistent with the characteristics of type 1 and type 2 antigens, respectively . These studies indicate that retinol status is an important determinant of the humoral immune response to certain types of antigen and suggest that antibody production to capsular polysaccharides and T cell-dependent antigens is particularly dependent on adequate retinol status.

J Exp Med, 1990 May 1, 171(5), 1535 - 46
Molecular cloning and characterization of the structural gene for the major iron-regulated protein expressed by Neisseria gonorrhoeae; Berish SA et al.; This report describes the cloning and sequencing of the major iron-regulated protein (termed Fbp) of Neisseria gonorrhoeae strain F62 . Attempts to identify recombinants expressing the Fbp using specific antibody proved unsuccessful . Therefore, an alternative cloning strategy using oligonucleotide probes derived from NH2-terminal and tryptic fragments of this protein was used to identify short fragments of the gene . Using this methodology, the gene encoding the precursor of Fbp was cloned on three separate overlapping fragments and sequenced, and the amino acid sequence was deduced . These data were unambiguously confirmed by the known NH2-terminal amino acid sequence and were supported by the sequences from tryptic fragments that lie outside of this region . Using oligonucleotide probes, we were unable to obtain clones encoding the potential regulatory region of this protein . Therefore, the technique of inverse polymerase chain reaction was used to amplify a fragment containing an additional 200 bp . This fragment was cloned and sequenced and found to contain a consensus ribosome binding site and potential -10 and -35 sequences . Hybridization analysis of genomic DNA from gonococcal strain F62 indicated that only a single copy of the Fbp gene exists per genome . These results complement the biochemical characterization of the Fbp expressed by gonococci and further suggest that it has a role in iron-acquisition.

J Bacteriol, 1990 May, 172(5), 2439 - 46
Identification and characterization of a new replication region in the Neisseria gonorrhoeae beta-lactamase plasmid pFA3; Gilbride KA et al.; The 7.1-kilobase-pair (kbp) plasmid pFA3 specifies TEM beta-lactamase production in Neisseria gonorrhoeae . We studied the minimal region required for replication of this plasmid in Escherichia coli by constructing a set of nested deletions of the 3.4-kbp PstI-HindIII fragment . The smallest fragment capable of maintenance in E . coli when ligated to a streptomycin-spectinomycin resistance cassette was 2.0 kbp in size and was different from another autonomously replicating fragment of pFA3 reported by K . H . Yeung and J . Dillon (Plasmid 20:232-240, 1988) . The fragment contained single BamHI and XbaI sites and specified a 39-K protein . Fragments subcloned from the minimal region or constructed by deletion from the 3' or 5' ends were not capable of autonomous replication . Mutants constructed by end filling and religating DNA cleaved at the BamHI or XbaI sites were not capable of autonomous replication and no longer produced the 39K protein . These results suggest that replication is dependent on the 39K protein . DNA sequence analysis of the region showed an A-T-rich region followed by four 22-bp direct repeats followed by an open reading frame encoding a 39K basic protein.

Ann Emerg Med, 1990 May, 19(5), 587 - 90
The prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis in victims of sexual assault; Sturm JT et al.; The prevalence of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in 232 sexual assault victims who presented for examinations between August 1, 1987, and July 31, 1988, was determined . Results are reported for cervical, rectal, and oropharyngeal NG cultures and for cervical and rectal CT smears . Results from a one-week follow-up are also reported . Cervical test results from the initial sexual assault examination were compared with cervical tests on 399 randomly selected female emergency department patients who presented for other gynecological conditions or lower abdominal pain . The victims of sexual assault had ten of 210 positive cervical NG cultures (4.76%), and 13 of 213 positive cervical CT smears (6.1%) at the first visit . These prevalence rates were not significantly different (P = .3058) . There were none of 28 positive rectal NG cultures (0%) and one of 22 positive rectal CT smears (4.34%) (P = .451) . None of the 43 oral NG cultures was positive . Seventy-three victims returned for follow-up examination . No follow-up cervical, rectal, or oral NG cultures were positive . However, one of 53 follow-up cervical smears for CT was positive, but this was not significantly different than for cervical NG (P = .461) . Sexually assaulted patients had ten of 210 (4.76%) cervical NG cultures positive, and nonassaulted patients showed 53 of 393 positives (13.4%) (P less than .001) . Assaulted patients had 13 of 213 (6.1%) cervical CT smears positive, and nonassaulted patients showed 33 of 352 (9.3%) positives (P = .11).(ABSTRACT TRUNCATED AT 250 WORDS)

J Clin Microbiol, 1990 May, 28(5), 944 - 8
Evaluation of an rRNA-derived oligonucleotide probe for culture confirmation of Neisseria gonorrhoeae; Rossau R et al.; The reliability of an rRNA-derived oligonucleotide probe for Neisseria gonorrhoeae was tested with 187 N . gonorrhoeae isolates, 81 Neisseria meningitidis isolates, and several strains of other bacterial species . The probe proved to be 100% specific and 100% sensitive . N . gonorrhoeae cells could also be reliably identified in contaminated cultures with the oligonucleotide probe . The 2.6-megadalton cryptic plasmid used as a probe for N . gonorrhoeae was shown to be less sensitive, detecting 179 of 181 N . gonorrhoeae isolates.

J Exp Med, 1990 May 1, 171(5), 1649 - 64
In vitro and in vivo modification of Neisseria gonorrhoeae lipooligosaccharide epitope structure by sialylation; Mandrell RE et al.; After growth of gonococci in the presence of cytidine monophospho-N-acetyl-neuraminic acid (CMP-NANA), their 4.5-kD lipooligosaccharide (LOS) component was increased by approximately 400 daltons, whereas the LOS of strains lacking the 4.5-kD component were unaffected . Expression of mAb-defined epitopes on the 4.5-kD component was decreased on LOS of strains grown in CMP-NANA, and treatment of the LOS with neuraminidase reversed this affect . Gonococci incubated with human PMNs also had decreased expression of the 4.5-kD+ epitopes . A detergent extract of gonococci incorporated radiolabeled NANA in the LOS, suggesting the presence of a sialyltransferase in gonococci . Exogenous sialyltransferases also could use LOS as an acceptor.

Ann Intern Med, 1990 Apr 15, 112(8), 610 - 23
Bacterial meningitis: recent advances in pathophysiology and treatment; Tunkel AR et al.; PURPOSE: To review recent advances in the understanding of pathogenic and pathophysiologic mechanisms underlying bacterial meningitis that may lead to the development of adjunctive strategies for treating this disorder . DATA IDENTIFICATION: Studies published from 1975 to 1989 were identified using Index Medicus and by reviewing the bibliographies of identified articles . STUDY SELECTION: We reviewed the experimental and human studies evaluating pathogenesis, pathophysiology, and antimicrobial treatment of bacterial meningitis, as well as those reviews that have contributed to our understanding of meningitis . DATA EXTRACTION: We evaluated the data on the pathogenesis, pathophysiology, and treatment of bacterial meningitis and considered in depth the information from animal models that may have potentially important applications in the treatment of human disease . RESULTS OF DATA SYNTHESIS: Penicillin and ampicillin remain the drugs of choice for meningitis caused by Streptococcus pneumoniae and Neisseria meningitidis . The third-generation cephalosporins have revolutionized the treatment of gram-negative bacillary meningitis; one such agent, ceftazidime, is also useful for treating Pseudomonas aeruginosa meningitis . Modification of subarachnoid space inflammation by anti-inflammatory agents may lessen many of the pathophysiologic consequences of bacterial meningitis . A recent study of adjunctive dexamethasone therapy in infants and children with bacterial meningitis showed that the incidence of long-term neurologic sequelae was lower in the corticosteroid group . CONCLUSION: Future therapy for bacterial meningitis will use recent developments in the understanding of pathogenic and pathophysiologic mechanisms underlying this disease . Additional studies using monoclonal antibodies against specific virulence factors and investigations into the production of inflammatory cytokines in response to bacterial cell products may lead to additional treatments that decrease the high morbidity and mortality in patients with bacterial meningitis.

Indian J Pathol Microbiol, 1990 Apr, 33(2), 157 - 60
A bacteriological study of purulent meningitis in children; Williamson M et al.; There was an increase in incidence of meningitis in children within the last three years at the Bai Yamunabai Laxman Rao Nair Charitable Hospital in Bombay . Out of 270 purulent samples, 60 (22.22 percent) were culture positive . Neisseria meningitidis showed an increase from one case in 1985 to 11 cases by the end of 1987 . Staphylococcus aureus was isolated from 6 percent cases, Streptococcus pneumoniae 15 percent, and Gram negative bacilli were predominant, isolation rate being 57 percent . Salmonella species were isolated from 6 (10 percent) cases . They were multidrug resistant type, some belonging to the rare zoonotic species.

Sex Transm Dis, 1990 Apr-Jun, 17(2), 99 - 101
Cefotetan therapy for gonococcal urethritis and cervicitis; Youssef RZ et al.; The authors compared the safety and efficacy of 0.5 and 1.0 g of cefotetan with that of 0.25 g of ceftriaxone in a 3:3:2 randomized distribution . Of 172 patients (96 men, 76 women) aged 18-43 years who were being treated at the Delgado Venereal Disease Clinic, New Orleans Health Department, for acute gonococcal urethritis or cervicitis, 123 were evaluable (81 men, 42 women) . All men and 16 women were initially symptomatic . All were culture positive for Neisseria gonorrhoeae . At the 4-8 day follow-up, cultures were negative for N . gonorrhoeae in all except one man and one woman, each of whom received cefotetan 0.5 g . Symptoms were eliminated 12-72 hr after therapy in all groups . Cefotetan was well tolerated, and there were few adverse experiences reported . Thus, the authors consider cefotetan safe and effective for the treatment of uncomplicated gonorrhea.

Genitourin Med, 1990 Apr, 66(2), 91 - 2
Gonococcal arthritis caused by auxotype P in a man with HIV infection; Moyle G et al.; The development of gonococcal arthritis is reported in a man with HIV infection and CDC Stage IVC2 disease . The diagnosis of disseminated Neisseria gonorrhoeae was facilitated by microbiological examination of a joint aspirate . The auxotype identified by culture was moderately resistant to penicillin, a characteristic which is highly unusual for an organism causing disseminated gonococcal infection . This case serves as an example of the role of HIV infection in the modification of host response to common pathogens and the need for clinicians to modify their management of disseminated gonococcal infection especially in immunosuppressed persons.

Genitourin Med, 1990 Apr, 66(2), 62 - 5
Towards developing a diagnostic algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae cervicitis in pregnancy; Braddick MR et al.; C trachomatis and N gonorrhoeae are major causes of maternal and neonatal morbidity and mortality in developing countries . To identify characteristics predictive of cervical infection, we examined pregnant women attending an antenatal clinic in Nairobi, Kenya . C trachomatis was isolated from 14/178 (8%), and N gonorrhoeae from 17 (10%); cervical infection with either pathogen was present in 28 (16%) . Two characteristics were independently predictive of cervical infection by logistic regression analysis; the presence of either endocervical mucopus or induced endocervical bleeding, relative risk 4.2 (95% confidence interval (CI) 2.2 to 8.0) and having more than one sexual partner during pregnancy, relative risk 3.3 (95% CI 1.4 to 7.6) . A screening programme for cervical infection which tested women with one or both risk markers would have a sensitivity of 68% (95% CI 51 to 85%) and a positive predictive value of 0.35 (95% CI 0.22 to 0.47) . In countries where resources are limited, diagnostic algorithms incorporating clinical signs and behavioural characteristics may be useful in identifying pregnant women at high risk of cervical infectionPIP: Chlamydia trachomatis and Neisseria gonorrhoea are major causes of maternal and neonatal morbidity in developing countries . 178 pregnant women attending an antenatal clinic in Nairobi, Kenya, were therefore examined in the attempt to identify characteristics predictive of cervical infection . Chlamydia trachomatis was isolated from 14 (8%) and Neisseria gonorrhoea from 17 (10%); cervical infection with either pathogen was present in 28 (16%) . Logistic regression analysis found that the presence of either endocervical mucopus or induced endocervical bleeding and having more than 1 sex partner during pregnancy were independently predictive of cervical infection . A screening program for cervical infection which tested women with 1 or both risk markers wold have a sensitivity of 68% and a positive predictive value of 0.35 . The authors conclude that countries with limited resources may use diagnostic algorithms and incorporate clinical signs and behavioral characteristics to help identify pregnant women at high risk of cervical infection .

J Clin Microbiol, 1990 Apr, 28(4), 774 - 80
Quantitative culture of endocervical Chlamydia trachomatis; Barnes RC et al.; We examined the number of Chlamydia trachomatis inclusions produced in the initial passage of cell cultures of endocervical specimens from 1,231 women with positive chlamydial cultures who attended a sexually transmitted diseases clinic . Youth, white race, oral contraceptive use, and concurrent infection by Neisseria gonorrhoeae were associated with high chlamydial inclusion counts . Youth, white race, and oral contraceptive use were independent determinants of a high chlamydial inclusion count in women without concurrent gonorrhea but not in women with gonorrhea . Results of our study suggest that the degree of chlamydial excretion from the infected cervix may be influenced by characteristics of the patient being tested and may affect the ability to detect C . trachomatis in different patient groupsPIP: The relationships between selected epidemiological variables and the number of organisms detected in 1st passage in cell culture of specimens obtained from patients at an Indiana sexually transmitted disease clinic who were infected with Chlamydia trachomatis was investigated . Endocervical C trachomatis was detected in the initial passage of cell culture in 1300 (25%) of the 5276 eligible women . 599 (46%) of these infected women were also infected with Neisseria gonorrhoeae . 1769 (34%) were oral contraceptive (OC) users and 780 (60%) were black . Inclusion count data were obtained for only 1231 chlamydia-infected women given the need to exclude pregnant women and IUD users . The inclusion count distribution was as follows: less than or equal to 100 IFU/ml, 25%; 101-1000 IFU/ml, 40%; 1001-10,000 IFU/ml, 21%; and over 10,000 IFU/ml, 14% . Multivariate analysis of these counts identified young age (under 20 years), current OC use, and concurrent gonorrhea as the most significant risk factors for endocervical C trachomatis . The cervical signs of ectopy, mucopus, and friability were also associated with chlamydial infection . Among women with gonorrhea, only concurrent trichomoniasis was associated with the inclusion count . A history of prior sexually transmitted diseases or the presence of concurrent infection with trichomoniasis were associated with lower inclusion counts . Since the degree of detectability of chlamydial excretion may be affected by certain patient characteristics such as those identified in this study, possible bias in chlamydial detection tests must be considered .

Genitourin Med, 1990 Apr, 66(2), 70 - 5
Syphilis, gonorrhoea and genital chlamydial infection in a Somali village; Ismail SO et al.; A total of 767 sera were collected from 187 men, 200 women and 380 children in a Somali village, Jambaluul . All sera were tested for syphilis serological markers by Venereal Diseases Research Laboratory (VDRL) and Treponema pallidum Haemagglutination Assay (TPHA) . Sera positive for both or either of these tests were further analysed for the presence of specific IgM antibodies by Solid Phase Haemadsorption Assay (SPHA) . A high and almost equal prevalence of TPHA positivity was found in men and women; 24% and 22.5%, respectively, and IgM antibodies were found in 3% and 4%, respectively . TPHA positivity significantly increased with age . Thus more than half of the villagers at the age of 45 years or more were TPHA positive . One percent of the children were TPHA positive . From all adults aged 15 years and above urogenital specimens were also taken for Chlamydia trachomatis antigen detection with an enzyme-amplified immunoassay (IDEIA) and Neisseria gonorrhoeae culture . Chlamydial genital infection was found in 6% of the men and 18% of the women . All gonococcal cultures were negative.

Clin Pharm, 1990 Apr, 9(4), 275 - 85
Treatment of pelvic inflammatory disease; Cunha BA; The pathogenesis, risk factors, microbiology, sequelae, diagnosis, and treatment of pelvic inflammatory disease (PID) are reviewed, and factors associated with the selection of effective, safe, and economical drug therapy are discussed . PID is an acute clinical syndrome not related to surgery or pregnancy that is caused by the spread of microorganisms from the vagina and cervix to the endometrium, fallopian tubes, and other adnexal structures . Primary PID, the most common form of the disease, is the result of the ascent of sexually acquired or endogenous lower genital tract microorganisms to the upper genital tract . Presence of a sexually transmitted disease is the most common risk factor for PID, but a previous episode of PID, multiple sexual partners, intrauterine device use, and young age are also risk factors . PID is classified as gonococcal or nongonococcal (i.e., caused by anaerobic and aerobic pelvic organisms) . The long-term consequences of PID are the most devastating aspects of the disease; infertility remains the most common sequela . Therapy of PID is aimed at preserving fertility, preventing long-term consequences, and relieving acute clinical symptoms . In areas in which penicillinase-producing Neisseria gonorrhoeae is endemic, therapy that is effective against penicillinase-producing N . gonorrhoeae is necessary . Gonococcal PID that is not penicillin resistant may be treated with a single intramuscular or oral dose of a penicillin; penicillin-resistant infection may be treated with a cephalosporin or ciprofloxacin . If chlamydia is a diagnostic consideration, a one- to two-week course of oral tetracycline or doxycycline (injectable-drug therapy is an alternative) should be added to the regimen . Single-agent therapy is a cost-effective alternative to combination regimens . Ampicillin-sulbactam is a cost-effective alternative to the more costly injectable cephalosporins or the combination regimens of an aminoglycoside plus clindamycin or metronidazole . With the increasing prevalence of PID in the United States, the selection of cost-effective antimicrobial therapy has important implications for the hospital pharmacist and the pharmacy and therapeutics committee.

Am J Epidemiol, 1990 Apr, 131(4), 683 - 92
Cytomegalovirus infection among women attending a sexually transmitted disease clinic: association with clinical symptoms and other sexually transmitted diseases; Pereira LH et al.; The prevalence rates of cytomegalovirus, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and herpes simplex virus infection were determined for 247 women attending a sexually transmitted disease clinic in Halifax, Nova Scotia between July 1983 and December 1985 . Isolation rates were 8.5%, 32.8%, 27.1%, 7.3%, and 6.5% for the five infectious agents, respectively . With multiple logistic regression analysis, the presence of cervical cytomegalovirus infection was independently associated with age less than 23 years and with gonococcal infection . Factors predictive of C . trachomatis infection included age less than 23 years, gonococcal infection, oral contraceptive use, and purulent discharge . Number of lifetime sexual partners was statistically associated only with herpes simplex virus infection . N . gonorrhoeae, C . trachomatis, and T . vaginalis were all independently associated with purulent discharge . Cytomegalovirus, N . gonorrhoeae, and C . trachomatis were statistically more likely to be present concurrently with other organisms than to be present as a single infection . Women with another genital infection were 6.5 times more likely to have cytomegalovirus than were women with no other genital infection . Of the 21 women with cytomegalovirus, only two had no other sexually transmitted disease . These findings suggest that N . gonorrhoeae and other sexually transmitted diseases may play a role in either the sexual transmission of or the reactivation of cervical cytomegalovirus infection.

Med Trop (Mars), 1990 Apr, 50(2), 241 - 3
{Rapid screening for beta lactamase of Neisseria gonorrhoeae in pus from blennorrhagia}; Herve VM et al.; The authors have evaluated in an isolated post, a method for rapid detection of penicillinase-producing Neisseria gonorrhoeae in urethral exudates . This method, easy to use and not very expensive, offers a good sensitivity, and could help in making for the therapeutic decision and in the epidemiological surveillance of Neisseria gonorrhoeae's resistance to penicillin.

Sex Transm Dis, 1990 Apr-Jun, 17(2), 67 - 71
Acquisition of beta-lactamase and TetM-containing conjugative plasmids by phenotypically different strains of Neisseria gonorrhoeae; Sarafian SK et al.; beta-lactamase plasmids confer high-level penicillin resistance on strains of Neisseria gonorrhoeae and may be mobilized between strains by conjugative plasmids . The authors examined 32 isolates belonging to 23 auxotype/serovar (A/S) classes to determine the frequency with which they acquired the 4.4-, 3.2-, and 3.05-megadalton (Mdal) beta-lactamase plasmids, respectively . The 3.05-Mdal beta-lactamase plasmid was not acquired by any isolate . Each of 22 isolates possessing only the 2.6-Mdal plasmid or both the 2.6- and 24.5-Mdal plasmids acquired the 4.4- and 3.2-Mdal plasmids at similar frequencies, and 12 (55%) acquired the 4.4- or 3.2-Mdal plasmids at a frequency of greater than or equal to 10(-3) per input recipient; all transconjugants acquired the 24.5-Mdal conjugative plasmid . Among ten isolates that lacked the 2.6-Mdal plasmid (plasmidless), seven isolates that included five PAU/IB-2, -16 isolates acquired neither the 4.4- nor 3.2-Mdal plasmid; three non-PAU isolates acquired both the 4.4- and 3.2-Mdal plasmids (10(-2)-10(-5) per input recipient) . All plasmidless isolates acquired the 25.2-Mdal TetM containing plasmid with frequencies ranging from 10(-1) to 10(-8) per input recipient . These data suggest that gonococcal strains possessing the 2.6-Mdal plasmid readily acquire the 4.4- and 3.2-Mdal beta-lactamase plasmids in vitro, whereas acquisition of these plasmids by strains lacking the 2.6-Mdal plasmid is strain dependent.

Sex Transm Dis, 1990 Apr-Jun, 17(2), 63 - 6
Antimicrobial susceptibility of Neisseria gonorrhoeae in Harare, Zimbabwe . Relationship to serogroup; Mason PR et al.; The authors investigated one hundred fifty-four isolates of Neisseria gonorrhoeae obtained from men, women, and infants in Harare, Zimbabwe, for in vitro susceptibility to various antibiotics and for reactivity with serogrouping antisera . The authors found sixty-four (42%) isolates to be WI serogroup and 90 (58%) to be WII/III . One hundred three isolates were penicillinase-producing N . gonorrhoeae (PPNG); although all of these showed resistance to penicillin, 14 isolates had an MIC to penicillin of less than 10 mg/L . All of these 14 isolates were WI serogroup . Twenty-seven of the 51 non-PPNG showed in vitro resistance to penicillin (MIC greater than 1.25 mg/L) . All but one of these chromosomally resistant isolates were WII/III serogroup . With cefuroxime, tetracycline, and erythromycin, 10-15% of isolates had MICs greater than accepted breakpoints . Most isolates were susceptible to thiamphenicol, and all were susceptible to ciprofloxacin, kanamycin, and spectinomycin . The authors noted that WI isolates, whether PPNG or not, were consistently more susceptible to antibiotics than WII/III isolates . Only with kanamycin and spectinomycin were the MICs of the two serogroups similar.

Genitourin Med, 1990 Apr, 66(2), 87 - 90
Antibiotic resistance, plasmid profile, auxotypes and serovars of Neisseria gonorrhoeae strains isolated in Sevilla (Spain); Palomares JC et al.; The antibiotics resistance pattern, the plasmid profile, the auxotypes and serotypes of 116 Neisseria gonorrhoeae clinical isolates obtained in one year were examined . The incidence of penicillinase producing (PPNG) strains was 12% (14 strains) . The most frequent plasmid pattern was the combination of 4.5, 2.6 and 24.5 MDa plasmids . The conjugative plasmid of 24.5 MDa showed a high prevalence (32% of the total strains), and almost all the PPNG strains harboured this plasmid . The strains with the 4.5 MDa plasmid belonged to the auxotypes Pro-, Zero and Pro-Hyx-Ura-, whereas that with the 3.2 MDa plasmid was of auxotype Pro-Hyx-His- . The serotypes Aedih/Arst (WI serogroup) and Bak/Bropt, Back/Bropyt and Bak/Bropyt (WII/III serogroup) were predominant.

Genitourin Med, 1990 Apr, 66(2), 82 - 6
Transfer of beta-lactamase plasmids by conjugation in Neisseria gonorrhoeae; Ison CA et al.; Conjugation experiments in vitro have been used in an attempt to explain certain epidemiological phenomena seen amongst penicillinase producing Neisseria gonorrhoeae (PPNG) isolated at St Mary's Hospital, London . These include changes in plasmid profiles, a lack of beta-lactamase encoding plasmids in PAOU-requiring strains and a difference in the serological classification of strains of PPNG and non-PPNG isolated from the same clinic . It was shown that acquisition of the conjugative plasmid by beta-lactamase producing transconjugants does vary, but is not related to the auxotype/serovar (A/S) class of, or type of beta-lactamase plasmid carried by the donor . It was not possible to transfer either the 3.2MDa or 4.4MDa plasmids to PAOU-requiring strains of N gonorrhoeae . The conjugation frequency from a single donor to different recipients was shown to be variable, but was not influenced by the serovar of the recipients . It was shown that the transfer and acceptance of beta-lactamase encoding plasmids is variable but it was not possible to identify the factors responsible.

Infect Immun, 1990 Apr, 58(4), 1078 - 84
Monoclonal antibodies to outer membrane protein PII block interactions of Neisseria gonorrhoeae with human neutrophils; Elkins C et al.; Nonopsonic binding of gonococci to human neutrophils appears to be mediated by a family of heat-modifiable outer membrane proteins termed protein IIs (PIIs) . We studied the ability of a wide variety of antigonococcal monoclonal antibodies (MAbs) to inhibit the interactions of nonpiliated PII+ gonococci with human neutrophils by measuring gonococcal adherence to neutrophils and subsequent luminol-enhanced neutrophil chemiluminescence . From one set of 95 MAbs reacting with whole gonococci, only two, 7VA2 and 7B9, inhibited the ability of gonococci to induce neutrophil chemiluminescence . 7VA2 and 7B9 both reacted only with PII . MAb 53C4, from a smaller set of anti-PII MAbs, inhibited adherence to neutrophils of PII variants that bound 53C4, but not of PII variants that did not . It also inhibited gonococcus-induced neutrophil chemiluminescence . Using a whole-cell binding assay and Western blotting (immunoblotting), we showed that MAb 53C4 bound to one PII (PII4) of strain F62 and to two PIIs (PIIb and PIId) of strain FA1090 . The present studies confirm and extend the role of PII in gonococcal adherence to and stimulation of human neutrophils and show intrastrain conservation of PII epitopes . The results indicate that PII is the only outer membrane component involved in adherence of nonpiliated gonococci to human neutrophils.

Am J Ophthalmol, 1990 Mar 15, 109(3), 329 - 33
The sensitivity of Neisseria gonorrhoeae, Chlamydia trachomatis, and herpes simplex type II to disinfection with povidone-iodine; Benevento WJ et al.; Povidone-iodine is an effective broad-spectrum disinfectant with no reported toxicity to the cornea and conjunctiva when applied topically in single dose to the ocular surface . We challenged four strains of Neisseria gonorrhoeae, a clinical isolate of Chlamydia trachomatis, and one strain of herpes simplex virus type II with three different concentrations of povidone-iodine (5%, 1%, and 0.1%) for one minute . The challenge inoculum of Neisseria gonorrhoeae and herpes simplex virus type II were completely sterilized by all three solutions . The chlamydia titer was reduced by two log units at the 5% and 1% concentrations, but not the 0.1% concentration . Povidone-iodine may be of potential use in the prophylaxis of newborns against ophthalmia neonatorum.

N Engl J Med, 1990 Mar 15, 322(11), 713 - 6
Sexually transmitted diseases in victims of rape; Jenny C et al.; The risk of acquiring a sexually transmitted disease as a result of rape is not known, in part because it is difficult to ascertain whether infections were present before the assault or acquired during it . To investigate this question, we examined female victims of rape within 72 hours of the assault and again at least one week after the assault . Of the 204 girls and women initially examined within 72 hours of the rape, 88 (43 percent) were found to have at least one sexually transmitted disease . These diseases included infections caused by Neisseria gonorrhoeae (6 percent of those tested), cytomegalovirus (8 percent), Chlamydia trachomatis (10 percent), Trichomonas vaginalis (15 percent), herpes simplex virus (2 percent), Treponema pallidum (1 percent), and the human immunodeficiency virus type 1 (HIV-1; 1 percent) and bacterial vaginosis (34 percent) . Among the 109 patients (53 percent) who returned for at least one follow-up visit (excluding those who were found to be infected at the first visit or who were treated prophylactically), the incidence of new disease was as follows: gonorrhea, 4 percent (3 of 71); chlamydial infection, 2 percent (1 of 65); trichomoniasis, 12 percent (10 of 81); and bacterial vaginosis, 19 percent (15 of 77) . There were no new infections with herpes simplex virus, cytomegalovirus, Trep . pallidum, or HIV-1, but follow-up serologic testing was performed in only 26 percent of the patients . On the basis of our assumptions that most venereal infections present within 72 hours of a rape were preexisting and that new infections identified 1 to 20 weeks later were acquired during the assault, we conclude that the prevalence of preexisting sexually transmitted diseases is high in victims of rape and that they have a lower but substantial additional risk of acquiring such diseases as a result of the assault.

J Biol Chem, 1990 Mar 5, 265(7), 3738 - 43
Inhibition of IgA1 proteinases from Neisseria gonorrhoeae and Hemophilus influenzae by peptide prolyl boronic acids; Bachovchin WW et al.; The alpha-aminoboronic acid analog of proline has been synthesized and incorporated into a number of peptides as the COOH-terminal residue . These peptide prolyl boronic acids are potent inhibitors of both the type 1 and type 2 IgA proteinases from Neisseria gonorrhoeae and Hemophilus influenzae, but not of the functionally similar IgA proteinase from Streptococcus sanguis . The best inhibitors synthesized thus far have Ki values in the nanomolar range (4.0 to 60 nM) . These results indicate that the N . gonorrhoeae and the H . influenzae enzymes belong to the serine protease family of proteolytic enzymes while that from S . sanguis does not . As a group, the IgA proteinases have been noted for their remarkable specificity; thus, the peptide prolyl boronic acids reported here are the first small synthetic molecules to exhibit a relatively high affinity for the active site of an IgA proteinase and are therefore the first to yield some insight into the active site structure and specificity requirements of these enzymes.

Infection, 1990 Mar-Apr, 18(2), 83 - 5
The role and prevalence of Gardnerella vaginalis in anaerobic vaginosis; Sehgal SC et al.; 310 cases of anaerobic vaginosis and 80 asymptomatic females were studied for the detection of various organisms from their genital specimens . The main complaint of the symptomatic cases was vaginal discharge . Neisseria gonorrhoeae, Candida albicans, Trichomonas vaginalis . Bacteroides species, anaerobic cocci and Gardnerella vaginalis were detected . The frequency of detection of all except C . albicans was less in pregnant than non-pregnant women . However, the prevalence of anaerobes and G . vaginalis was significantly lower in both the symptomatic and asymptomatic pregnant than the non-pregnant women . G . vaginalis showed mutualism with anaerobic bacteria and was not isolated as a pure culture in any of the cases . It appears that G . vaginalis, like anaerobes, has variable prevalence rates and is under the influence of local physiological and hormonal factors . This organism does not appear to have a primary pathogenic role, but assumes a secondary role in association with non-sporing anaerobes in the pathogenesis of anaerobic vaginosis.

J Reprod Med, 1990 Mar, 35(3 Suppl), 329 - 32
Antibiotic therapy for pelvic inflammatory disease; Pastorek JG 2nd; Pelvic inflammatory disease (PID) is a serious illness with important medical and economic consequences, especially for young women . To make a significant impact on the acute and chronic morbidity associated with PID, experts currently recommend aggressive hospitalization and parenteral antimicrobial therapy . Antibiotic therapy, in the 1989 recommendations of the Centers for Disease Control, includes broad-spectrum cephalosporins active against penicillinase-producing Neisseria gonorrhoeae and the mixed aerobic and anaerobic genital flora, with concomitant administration of doxycycline for possible or proven infection with Chlamydia trachomatis . An alternative regimen consists of the "gold standard" combination of clindamycin plus an aminoglycoside . However, with the availability of beta-lactam/beta-lactamase-inhibitor combinations, such as ticarcillin/clavulanate and ampicillin/sulbactam, which have modest to very good activity against all these classes of bacteria, the gynecologist has the capability to utilize single-agent antibiotic regimens to adequately treat this potentially devastating sexually transmitted disease.

Cesk Epidemiol Mikrobiol Imunol, 1990 Mar, 39(2), 78 - 87
{Serotyping and subtyping strains of Neisseria meningitidis isolated from patients in Czechoslovakia 1975-1986}; Kuzemenska P et al.; The paper presents results of serotyping and subtyping of 181 strains of N . meningitidis isolated from patients in the CSR during 1975-1988 . A new method of whole-cell ELISA with monoclonal antibodies was used . During the investigation period in strains of N . meningitidis serogroup A only serotype 4 was detected (68.4%) and no subtype was found . In N . meningitidis, serogroups B and C, heterogeneity of serotypes and subtypes was found and a relatively high percentage of strains where the type or subtype could not be detected . In N . meningitidis serogroup B serotype 15 (11.0%) and 4 (8.2%) and subtype P1.15 (14.9%) and P1.2 (12.9%) predominated . In N . meningitidis serogroup C serotype 4 (28.8%) and 15 (7.7%) and subtype P1.2 (21.1%) and P1.6 (11.6%) prevailed . This detected heterogeneity of serotypes and subtypes corresponds to the findings of other authors during non-epidemic conditions . The authors present the most frequent combinations of serotypes and subtypes in strains of different serological groups A : 4 : NT, B : NT : P1.2, B : 4 : P1.15, B : 15 : 1.15, B : 15 : NT, C : 4 : NT, C : NT : P1.2 . The work confirms the homogeneity of antigenic properties of N . meningitidis strains isolated from one focus.

Clin Ther, 1990 Mar-Apr, 12(2), 101 - 4
Spectinomycin-resistant gonococci in Thailand; Traisupa A et al.; The incidence of resistance to spectinomycin was determined in 3,200 isolates of Neisseria gonorrhoeae from male and female patients at four venereal disease clinics in Thailand . Susceptibility of the isolates was tested on disks containing 100 micrograms of spectinomycin . There was no evidence of spectinomycin resistance (a zone of inhibition of less than or equal to 18 mm in diameter); the diameter of the inhibitory zone was 19 to 23 mm in 10.9% of the isolates, 24 to 28 mm in 53.7%, 29 to 33 mm in 31.3%, 34 to 38 mm in 4.1%, and 39 mm in 0.05% . The results were similar in the male and female patients.

Microb Pathog, 1990 Mar, 8(3), 227 - 33
Distribution of gonococcal lipopolysaccharide biosynthesis genes among strains of Neisseria gonorrhoeae and other neisserial species; Palermo-Dilts DA et al.; A plasmid, pTME6, containing Neisseria gonorrhoeae lipopolysaccharide biosynthesis genes was used as a probe to analyze DNA from strains of N . gonorrhoeae, N . meningitidis and various commensal Neisseria by Southern blotting . Chromosomal DNA from 26 gonococcal strains probed with 32P-labeled pTME6 produced five different hybridization patterns . No correlation between hybridization pattern and auxotype, serotype, serum sensitivity or SDS-urea-PAGE migration of LPS was observed . DNA from strains of N . meningitidis, N . lactamica and N . cinerea, but not other commensal Neisseria species, hybridized strongly to pTME6.

Kansenshogaku Zasshi, 1990 Mar, 64(3), 280 - 3
{Detection of African type penicillinase-producing Neisseria gonorrhoeae in Japan}; Okazaki T et al.; The Plasmid DNA patterns of 22 penicillinase-producing Neisseria gonorrhoeae (PPNG) strains isolated from male patients with gonococcal urethritis in 1988 at Tokyo Metropolitan Taito Hospital were determined . The 3.3 megadalton plasmid, the so called the African type plasmid, was present in 3 isolates out of 22 PPNGs, all of which occurred with a conjugative 24.5 megadalton plasmid . 4.4 megadalton plasmid was present in 19 isolates out of 22 PPNGs, 5 of which occurred with a conjugative 24.5 megadalton plasmid . The infective sources of the 3 cases of the African type PPNGs were found as 1 from philippines and 2 from prostitutes, so called Soap Land Girl in Japan . And they suggests that the African type PPNGs are already common in Japan.

Eur J Epidemiol, 1990 Mar, 6(1), 96 - 8
Detection of a novel "cryptic" plasmid of about 7.8 MDal in a non-penicillinase-producing Neisseria gonorrhoeae isolate from Munich; Abeck D et al.; A novel plasmid of about 7.8 megadaltons (MDal) could be detected in a non-penicillinase-producing Neisseria gonorrhoeae strain isolated in Munich in 1987 . As the strain showed no resistance against commonly used chemotherapeutic agents, at present the plasmid must be described as phenotypically "cryptic".

Eur J Epidemiol, 1990 Mar, 6(1), 91 - 5
Current status of serotyping of Neisseria gonorrhoeae; Kohl PK et al.; Protein I has become the basis of serotyping of N . gonorrhoeae . A panel of 12 anti-protein I monoclonal antibodies is supplied by Syva Company, Palo Alto, CA, through distributors for research purposes only . These distributors are responsible for storing the monoclonal antibodies, supplying research groups and training new users, particularly in the interpretation of coagglutination reactions . A European Workshop was held in Heidelberg, Federal Republic of Germany in July 1988 to discuss serotyping with these antibodies . The current uses of serotyping of N . gonorrhoeae include epidemiological studies, clinical purposes and surveillance of antibiotic resistance and plasmid carriage . Predominant serovars may be subtyped either by additional antibodies or with the use of another technique, such as auxotyping, determination of antibiotic sensitivities, plasmid analysis or genetic fingerprinting . Conversely, there is growing evidence that it may be appropriate to group certain serovars together . Data collected during prevalence studies could be combined with clinical information and an international data bank set up . This supposes a close future collaboration of all groups involved in the epidemiology of N . gonorrhoeae.

Eur J Epidemiol, 1990 Mar, 6(1), 1 - 8
Gonococcal infection within Scotland: antigenic heterogeneity and antibiotic susceptibility of infecting strains; Young H et al.; Two panels of monoclonal antibody reagents were used to serotype all strains of Neisseria gonorrhoeae isolated from four separate geographical areas serving two million of the five million Scottish population . Serotype 1B isolates accounted for 60% of the 869 strains examined and were more prevalent than 1A isolates in each geographical area . A total of 11 1A serovars and 47 1B serovars were recognised . Only two of the 11 1A serovars (Aedgkih/Arost and Aedih/Arst) were found in every centre but these accounted for over 90% of the 1A isolates . Although there was a total of 47 different 1B serovars over 80% of the isolates were accounted for by the ten most commonly encountered serovars . There were, however, marked geographical differences within both major and minor serovars . There was a highly significant difference (P less than 0.001) between protein 1A and 1B serovars with respect to their susceptibility to penicillin . Within each protein 1 type there were also differences in antibiotic susceptibility . Penicillinase-producing N . gonorrhoeae (PPNG) were found in all centres and accounted for 24 (2.8%) of the 869 isolates . The majority of the PPNG (71%) were serotype 1A and with one exception were serovar Aedih/Arst . PPNG strains accounted for 37% (16) of the 43 Aedih/Arst isolates . Epidemiological, diagnostic and therapeutic implications arising from the distinct geographical differences in the pool of circulating gonococci are discussed.

Zentralbl Bakteriol, 1990 Mar, 272(3), 313 - 7
Increase of the relative frequency of penicillinase-producing Neisseria gonorrhoeae strains to more than five per cent in Munich; Korting HC et al.; The relative frequency of penicillinase-producing Neisseria gonorrhoeae strains isolated from Munich STD patients nowadays clearly exceeds five percent . Penicillin resistance is either due to the 3.2 or 4.4 Megadalton plasmid . Similar trends are reported from other European countries . Therefore, treatment with third generation cephalosporins such as ceftriaxone, cefotaxime or others is now generally advisable not only in the Far East and Central Africa but also in Central Europe.

J Clin Microbiol, 1990 Mar, 28(3), 619 - 20
Two confirmatory tests for identification of Neisseria gonorrhoeae from primary culture; Ridderhof JC et al.; We compared a fluorescent monoclonal antibody and a DNA probe for identification of Neisseria gonorrhoeae (GC) from primary genital cultures of presumptive GC and selected bacterial isolates other than GC . The monoclonal antibody was sensitive (94%) and specific (100%) enough to identify GC in selective primary genital culture . The DNA probe was sensitive (95%) but not adequately specific (65%) to function as a confirmatory test.

Infect Immun, 1990 Mar, 58(3), 719 - 25
Synthesis of a select group of proteins by Neisseria gonorrhoeae in response to thermal stress; Woods ML 2nd et al.; We report the thermal conditions that induce the heat shock response in Neisseria gonorrhoeae . Under conditions of thermal stress, Neisseria gonorrhoeae synthesizes heat shock proteins (hsps), which differ quantitatively from conventionally studied gonococcal proteins . Gonococci accelerate the rate of synthesis of the hsps as early as 5 min after the appropriate stimulus is applied, with synthesis continuing for 30 min, as demonstrated by in vivo labeling experiments with L-{35S}methionine . Two of the gonococcal hsps are immunologically cross-reactive with the hsps of Escherichia coli, DnaK and GroEL, as demonstrated by Western blot (immunoblot) analysis . Ten hsps can be identified on two-dimensional autoradiograms of whole gonococci (total protein) . Four hsps can be identified on two-dimensional autoradiograms of 1% N-lauroylsarcosine (sodium salt) (Sarkosyl)-insoluble membrane fractions . Two of the hsps from the 1% Sarkosyl-insoluble fraction are found exclusively in this fraction, suggesting that they are membrane proteins . The identification of this group of proteins will facilitate further study of the function of these proteins and provide insight into the possible role of hsps in disease pathogenesis.

Mol Microbiol, 1990 Mar, 4(3), 321 - 7
The role of transformation in the variability of the Neisseria gonorrhoeae cell surface; Scocca JJ; This review discusses the genetic basis for surface changes in Neisseria gonorrhoeae and the role of specific transformation reactions in producing them . Variation in the structure of pilin, the subunit of gonococcal pili, occurs by transformation-mediated recombination of DNA segments in storage loci with the expression locus . These pilin loci have low recombination potential since their sequences contain only short uninterrupted identical sequences . The DNA within storage or silent loci are also relatively deficient in the short defined sequences which target DNA for efficient uptake and thus have relatively low affinity for the DNA transport system . Consequently, pilin-encoding DNA segments constitute relatively poor substrates for the general transformation system of gonococci . These considerations suggest the existence of locus-specific factors which increase the efficiency of genetic exchange between pilin loci . I raise the speculative hypothesis that one function of transformation-mediated DNA entry is to provide a regulatory stimulus signalling the death of neighbouring gonococci . This regulatory shift might lead to production of factors which accelerate genetic reshuffling of pilin loci either by transformation per se using external DNA as donor, or via a recombinational process which utilizes internally derived DNA segments as donors . A signalling function for transforming DNA also clarifies several general properties of specific transformation reactions.

Mol Microbiol, 1990 Mar, 4(3), 439 - 49
Characterization of the repertoire of hypervariable regions in the Protein II (opa) gene family of Neisseria gonorrhoeae; Connell TD et al.; P.II outer membrane proteins of Neisseria gonorrhoeae are encoded by a family of closely related genes . Although the genes are highly conserved, major differences in sequence among them occur in two short regions, designated hypervariable regions 1 (HV1) and 2 (HV2) . In this study, we determined the number and DNA sequence of the hypervariable regions in the P.II genes of strains FA1090 . The FA1090 chromosome contained at least eleven P.II loci, having six different versions each of HV1 and HV2 among them . Southern blotting with HV-specific oligonucleotides showed that each version was present in one to three copies, and that there were nine unique combinations of HV1 and HV2 in the P.II genes . Although each of the versions of HV1 or HV2 had a unique DNA sequence, there were some similarities among them, particularly when certain ones were compared . Restriction fragments containing only the HV regions were cloned into an expression vector to demonstrate that the epitopes recognized by a set of monoclonal antibodies specific for different FA1090 P.II proteins were completely encoded by either HV1 or HV2.

Ugeskr Laeger, 1990 Feb 12, 152(7), 475 - 7
{Infections caused by Branhamella catarrhalis}; Ejlertsen T et al.; Branhamella catarrhalis, formerly Neisseria catarrhalis, is a common bacteriological finding in the upper respiratory tract in infancy, and it ranks third on the list of bacterial causes of otitis media and sinusitis . In adults Branhamella catarrhalis may cause acute exacerbations of bronchitis and pneumonia, especially in patients with chronic lung disease . Branhamella catarrhalis is being recognized more frequently as a nosocomial pathogen and it may cause septicaemia in immunocompromised patients . Resistance to penicillin is prevalent and is due to production of beta-lactamases . The pathogenic potential of this agent should not be overlooked.

J Biol Chem, 1990 Feb 5, 265(4), 2278 - 85
Biochemical purification and crystallographic characterization of the fiber-forming protein pilin from Neisseria gonorrhoeae; Parge HE et al.; Pilus fibers are long protein filaments on many pathogenic bacteria that participate in attachment to host cells . Although the self-assembling protein pilin is the major structural component of the Neisseria gonorrhoeae pilus fiber, several other proteins co-purified with pilin through the repeated solubilization-reassociation steps of the biochemical purification . Pilin solubilized in the nondenaturing detergent n-octyl-beta-D-glucopyranoside remained an aggregate of about 100 kDa at pH 9.5, but was reduced to a 40-kDa dimer at pH 10.5, suggesting that assembly involves electrostatic interactions of lysine, tyrosine, or other side chains with high pKa values . Pilin dimers and aggregates of higher molecular mass were partially stable even in the presence of sodium dodecyl sulfate and beta-mercaptoethanol . Removal of pilus-associated proteins and stabilization of pilin multimers permitted the reproducible crystallization of pilin . Three-dimensional needle- and plate-shaped crystals of purified N . gonorrhoeae pilin (strain MS11 variant C30) grew from 36 to 40% polyethylene glycol 400, pH 8.0-9.0, in space group C222, with cell dimensions a = 126.4, b = 121.2, c = 26.7 A and Vm = 2.84 A3/dalton for one molecule per asymmetric unit . The best crystals diffracted to 2.4 A resolution using synchrotron radiation, were stable to x-ray damage, and appear suitable for determination of the atomic structure . This approach of stabilizing and crystallizing an intermediate assembly state may be useful for other fiber-forming proteins, which have previously not been successfully crystallized in forms that diffract to atomic resolution.

Obstet Gynecol, 1990 Feb, 75(2), 282 - 6
Comparative evaluation of clindamycin versus clindamycin plus tobramycin in the treatment of acute pelvic inflammatory disease; Gall SA et al.; Fifty-one hospitalized women were treated with either clindamycin phosphate alone (N = 23) or a combination of clindamycin phosphate plus tobramycin (N = 28) for community-acquired pelvic inflammatory disease . The overall regimen clinical success rates were 100 and 91% for the clindamycin/tobramycin and clindamycin-alone groups, respectively . Efficacy for patients with positive pre-treatment Neisseria gonorrhoeae cultures was eight of eight (100%) for the clindamycin/tobramycin group and seven of eight (88%) in the clindamycin-alone group . Of the total population studied, 15 of 51 (29%) had positive pre-treatment cultures for Chlamydia trachomatis, and a microbiologic cure was attained in 15 of 15 (100%) . However, in two of 15 (14.5%), the patient did not return for the 6-week culture, although the culture at discharge from the hospital was negative . No serious adverse reactions were observed, although oral follow-up treatment with clindamycin had to be discontinued in one patient because of diarrhea, which resolved without additional therapy . The results suggest that intravenous clindamycin alone is a viable alternative to the use of clindamycin/tobramycin for women with acute pelvic inflammatory disease requiring hospitalization.

Br Heart J, 1990 Feb, 63(2), 134 - 5
Gonococcal arthritis complicated by acute pericarditis and pericardial effusion; Wilson J et al.; A woman of 23 presented with a painful, swollen left knee . A thick yellow fluid aspirated from the joint cavity grew Neisseria gonorrhoeae . Central pleuritic chest pain and ST segment elevation developed 48 hours after presentation . These signs and symptoms of pericarditis had settled two months after the acute illness.

Epidemiol Infect, 1990 Feb, 104(1), 47 - 53
A prospective study of genital infections in a family-planning clinic . 1 . Microbiological findings and their association with vaginal symptoms; Riordan T et al.; A prospective study of genital infection was conducted in four inner-city family-planning clinics . Fifteen per cent of routine attenders had symptoms and signs of vaginal infection and many more women attended primarily because of symptoms . Among the women with both signs and symptoms, 70% had positive laboratory findings, Trichomonas vaginalis, Candida albicans and bacterial vaginosis being equally prevalent . Measurement of vaginal pH in the clinic was the single most useful clinical finding for directing empirical therapy . Among patients with a discharge confirmed on examination and an abnormally high pH, 72% had either T . vaginalis or bacterial vaginosis . Neisseria gonorrhoeae was isolated from 4% of women with, and 1% of those without, symptoms . We believe that it is worthwhile to investigate patients presenting to family-planning clinics with vaginal symptoms . No single specimen was found ideal for all pathogens, a cervical swab is better for gonococci and also for T . vaginalis but a vaginal swab is needed for candida and bacterial vaginosisPIP: 495 clients of 4 Manchester Family Planning Clinics, consulting for gynecological symptoms (194) or contraception (269), were examined to determine the prevalence of STD organisms and to rate signs, symptoms and laboratory findings for decisions about future screening . 38% of the family planning patients has symptoms of genital infection when asked . The 2 patients groups were combined, and signs and symptoms as well as laboratory results separated to establish criteria for lab screening . Among women with both signs and symptoms, 70% has positive laboratory findings . Trichomonas vaginalis, Candida albicans and bacterial vaginosis occurred in 22-26% of women with vaginal discharge . 72% of women with vaginal pH 4.5 has trichomonas and/or clue cells compared with 15% of those with normal pH . Cervicitis or cervical contact bleeding was associated with trichomonas . Candida, but not clue cells, was linked with vaginal inflammation . N . gonorrhoea was isolated from 12 women (2.4%), 10 of whom has symptoms . These results suggest that women with high pH could be given metronidazole before laboratory confirmation; that bacterial infection can be diagnosed by vaginal discharge, high pH and clue cells; that cervical swabs are more accurate than vaginal swabs for determining trichomonas; and that cervical smears for cytology are equally good for trichomonas; and that the high prevalence of gonococci justifies use of a culture medium that will also support growth of Candida .

Am J Obstet Gynecol, 1990 Feb, 162(2), 343 - 7
Clindamycin therapy for Chlamydia trachomatis in women; Campbell WF et al.; The population for this study consisted of 4013 sexually active women seen for family planning . Culture for Chlamydia trachomatis yielded an isolation rate of 6.1% . Women aged 16 to 25 accounted for 81.7% of the C . trachomatis infections, while those younger than 16 or older than 35 accounted for only 2.4% of the infections . Of the 246 patients whose cultures were positive for C . trachomatis, 159 (65%) were asymptomatic . The incidence of C . trachomatis was 11.2% among those with symptoms but only 6.4% among the asymptomatic group . Among 63 patients with Neisseria gonorrhoeae (who were excluded from the study), 26 (41.3%) also were infected by C . trachomatis . There were no microbiologic drug failures with erythromycin or clindamycin . Of 56 patients who enrolled in the clindamycin arm of the protocol, 48 (85.7%) completed therapy and experienced microbiologic and clinical cures . In contrast, erythromycin therapy was completed by only 25 of 57 women (43.9%) enrolled . The number of side effect failures for erythromycin was 22 of 57 (38.6%) . This was more than five times the number of side effect failures for clindamycin (4 of 56, or 7.1%).

Am J Surg Pathol, 1990 Feb, 14(2), 167 - 75
Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis; Kiviat NB et al.; To define and quantitate histologic changes in the endometrium that best correlate with documented upper genital tract infection (UGTI) and laparoscopically diagnosed acute salpingitis, we studied endometrial biopsy specimens from 69 consecutive patients with clinically suspected acute pelvic inflammatory disease (PID) who underwent microbiological evaluation for UGTI and laparoscopic examination for acute salpingitis . Both UGTI and acute laparoscopically confirmed salpingitis were present in 37 patients (54%), UGTI without salpingitis in 1 (1%), salpingitis without UGTI in 11 (16%), and neither UGTI nor salpingitis in 20 (29%) . Chlamydia trachomatis or Neisseria gonorrhoeae UGTI was found in 34 women, Escherichia coli in two patients, Peptococcus magnus in one woman, and with Streptococcus agalactiae in one woman . The following features were correlated both with UGTI and with salpingitis: presence of any neutrophils in the endometrial surface epithelium; neutrophils within gland lumens; dense subepithelial stromal lymphocytic infiltration; any stromal plasma cells; and germinal centers containing transformed lymphocytes . The simultaneous presence of five or more neutrophils per X 400 field in endometrial surface epithelium, together with one or more plasma cell per X 120 field in endometrial stroma, was the best predictor of UGTI plus salpingitis . This combination had a sensitivity of 92% and a specificity of 87% for predicting the diagnosis of both UGTI and laparoscopically confirmable acute salpingitis . Prospective studies are needed to assess the usefulness of these criteria.

Zh Mikrobiol Epidemiol Immunobiol, 1990 Feb, (2), 3 - 7
{The regulating action of oxygen on the nutritional requirements of Neisseria meningitidis}; Basnak'ian IA et al.; The study has revealed regularities in changing nutritional requirements of Neisseria meningitidis with changes in the degree of the oxygen saturation of the culture medium in a fermenter under the conditions of the controlled cultivation of N . meningitidis in a synthetic culture medium in the process of batch, semicontinuous and continuous flow cultivation . As shown in this study, when oxygen supply is limited, the consumption of carbohydrates prevails, while in the presence of surplus oxygen the prevalence of the consumption of amino nitrogen is observed.

Can J Microbiol, 1990 Feb, 36(2), 145 - 7
Receptors for transferrin in pathogenic bacteria are specific for the host's protein; Schryvers AB et al.; Transferrin receptors detected by a solid-phase binding assay were shown to be specific for the host's transferrin in the representative bacterial pathogens Neisseria meningitidis (human), Pasteurella haemolytica (bovine), and Actinobacillus pleuropneumoniae (porcine) . Consistent with the receptor specificity, iron-deficient bacteria were only capable of utilizing transferrin from the host as a source of iron for growth.

Antimicrob Agents Chemother, 1990 Feb, 34(2), 371 - 2
In vitro activity of cefpodoxime proxetil (U-76,252; CS-807) against Neisseria gonorrhoeae; Schaadt RD et al.; Cefpodoxime proxetil is an oral cephalosporin antibiotic . The in vitro activities of cefpodoxime (the active metabolite of cefpodoxime proxetil), ceftriaxone, and cefuroxime against both antibiotic-susceptible and antibiotic-resistant clinical isolates of Neisseria gonorrhoeae were determined . Cefpodoxime inhibited all penicillin-susceptible strains and penicillinase-producing strains at less than or equal to 0.015 microgram/ml; chromosomally resistant strains were inhibited by cefpodoxime at less than or equal to 0.125 microgram/ml.

Pathol Biol (Paris), 1990 Feb, 38(2), 89 - 92
{Evaluation of the bactericidal effect of the membrane attack complex of serum complement}; Ponard D et al.; The bactericidal activity of serum complement and particularly of the membrane attack complex (MAC-C5b-C9) was studied on E . coli C600 with a simple functional test . The test evaluates the in vitro kinetics of the bactericidal effect and the subsequent counting of surviving germs . Homozygous deficiency of a particular membrane attack complex protein was easily detected from a total loss of bactericidal activity . These results were confirmed on Neisseriae meningitidis A and C, but in this case a more complex protocol was required . Deficits of proteins of the membrane attack complex sequence of complement are often found in sera of patients suffering from recurrent Neisseriae infections . This simple test, adapted to family studies, appears, thus, as a valuable basis for a detection of relatives at risk.

Genitourin Med, 1990 Feb, 66(1), 8 - 13
Use of a quality assurance scheme in a long-term multicentric study of antibiotic susceptibility of Neisseria gonorrhoeae; Tapsall JW; Experience with a quality control programme for a multicentric collaborative study of antibiotic susceptibility of Neisseria gonorrhoeae is described . The Australian Gonococcal Surveillance Programme (AGSP) has monitored the antibiotic sensitivity of gonococci by surveying results of quantitative sensitivity tests performed in a number of centres throughout the country since 1981 . A standardised system of testing by means of agar plate dilution was adopted to ensure uniformity of methods and results and to permit temporal and regional differences in antibiotic sensitivity to be identified and compared . A control programme was developed to provide quality assurance regarding each laboratory's performance . Over a period of nine years more than 3600 MIC determinations on control strains, examined as unknowns, were performed . An overall error rate of 3.1% was observed . Higher error rates were noted in the beginning of the programme but these declined as the study progressed . In addition repeat and duplicate testing of strains was performed . The results of these tests also indicated an improvement in performance over the study period . Close attention to all aspects of the testing procedure reduced the number of errors recorded . At the beginning of the programme, various factors were investigated as possible causes of error . The formulation and preparation of media were found to be potential sources of result variation . Once these variables were controlled, lack of experience with end-point determination and errors in preparation of dilutions of antibiotic solutions emerged as the commoner causes of discrepancy . In the experience of the AGSP, a long-term multicentric evaluation of gonococcal sensitivity can achieve accurate and reproducible results through standardisation of methods and application of a continuing quality assurance scheme.

Infect Immun, 1990 Feb, 58(2), 569 - 72
Variation in expression of class 1 and class 5 outer membrane proteins during nasopharyngeal carriage of Neisseria meningitidis; Woods JP et al.; Accidental nasopharyngeal colonization of a laboratory worker by a human disease isolate of Neisseria meningitidis allowed us to examine the variation in expression of outer membrane components and the host humoral response over time . There were quantitative differences in class 1 outer membrane protein expression in nasopharyngeal isolates obtained at different times . Isolates also showed phase variation of all four class 5 outer membrane proteins produced by the colonizing strain . After colonization, we detected new host serum immunoglobulin G antibodies directed against class 1, class 5, and H.8 outer membrane proteins.

J Infect Dis, 1990 Feb, 161(2), 336 - 9
Localization of and immune response to the lipid-modified azurin of the pathogenic Neisseria; Trees DL et al.; The development of vaccines to prevent Neisseria infections has been impeded by antigenic diversity of most Neisseria surface components . The lipid-modified azurin (Laz), one of two distinct surface proteins recognized by the H.8 monoclonal antibody, is present in all pathogenic Neisseria . The mature protein has two domains; one contains an H.8 epitope and the other has extensive homology to azurins, a class of bacterial copper-binding proteins . The cellular location of Laz and the serum immune response to Lax were examined in patients with disseminated Neisseria infections . The data demonstrated that Laz is probably contained in the Neisseria outer membrane, although unlike most outer membrane proteins it is Sarkosyl soluble . By probing recombinant bacteriophages encoding the H.8 and azurin domains of Laz, results showed that whereas the H.8 epitope is immunogenic in patients with disseminated Neisseria infections, the azurin domain of Laz plays little role in eliciting an antibody response in these patients.

Gene, 1990 Jan 31, 86(1), 103 - 6
DNA methylation in Neisseria gonorrhoeae and other Neisseriae; Ritchot N et al.; It has been reported in the literature that Neisseria gonorrhoeae DNA is modified by the methyltransferases (MTases) M.NgoI, M.NgoII, and M.NgoIII, as well as three other cytosine MTases and one adenine MTase, even if the corresponding restriction endonucleases are not present . We envisioned the possibility of cloning one of the N . gonorrhoeae MTase-encoding genes for use as a species-specific DNA probe . We therefore undertook a survey of methylation patterns of several clinical isolates of N . gonorrhoeae and N . meningitidis as well as ATCC strains of other Neisseriae . We found, from digestion patterns with isoschizomers, one N . gonorrhoeae strain that lacked M.NgoII and two that lacked M.NgoIII . All N . meningitidis strains (save one) were resistant to digestion with NlaIV thus possessing an MTase like NgoV, and one was resistant to SstII, thus having an NgoIII-like MTase . None were resistant to isoschizomers of NgoI, NgoIII and NgoIV . Some other Neisseriae had an MTase with NlaIV (NgoV) specificity, but none had NgoI, II, III or IV specificity, except for the Branhamella-like N . caviae-ovis group and N . lactamica where these specificities were present in at least one strain of this group . Therefore, among the Neisseriae other than N . caviae only M.NgoI is N . gonorrhoeae-specific.

Can Dis Wkly Rep, 1990 Jan 20, 16(3), 13 - 6
Cases of Neisseria gonorrhoeae with plasmid-mediated resistance to penicillin increase . The National Study Group; Yeung KH et al.; Penicillinase-producing isolates of Neisseria gonorrhoeae (PPNG) were submitted to the National Laboratory for Sexually Transmitted Diseases for biological and genetic identification as part of an on-going national surveillance program for monitoring antibiotic-resistant gonococci . The primary identification of the isolates was completed in provincial laboratories . The isolates were documented and forwarded to LCDC through the provincial laboratories and provincial epidemiologists . Duplicate isolates from the same patient were excluded from the final analysis; retrospective clinical and epidemiological data were collected for each case . In those cases where PPNG isolates were not available for testing at LCDC, epidemiological and clinical data were included for statistical consideration . These data were collectively analyzed using computer programs developed within the National Laboratory for Sexually Transmitted Diseases.

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